• Tidak ada hasil yang ditemukan

BAB V KESIMPULAN DAN SARAN

5.2 Saran

1. Dengan ditemukannya peningkatan kadar CRP pada penderita PPOK eksaserbasi lebih tinggi dibanding dengan penderita PPOK stabil membuktikan bahwa kondisi inflamasi pada penderita PPOK eksaserbasi lebih tinggi dibanding kondisi stabil maka kadar CRP yang tinggi ini (> 10 mg/dl) memberikan informasi sebagai prediktor terhadap eksaserbasi.

2. Perlu dilakukan penelitian lebih lanjut mengenai pengaruh terapi antiinflamasi inhalasi ataupun sistemik terhadap kadar CRP pada penderita PPOK eksaserbasi secara berkelanjutan dan mencakup sampel yang lebih banyak lagi.

3. Salah satu pencetus eksaserbasi adalah infeksi bakteri, penelitian ini tidak membahas pengaruh infeksi terhadap kadar CRP pada penderita PPOK sehingga perlu dilakukan penelitian lebih lanjut mengenai hubungan antara nilai lekosit ataupun hasil mikrobiologi dengan kadar CRP pada penderita PPOK eksaserbasi dan stabil.

4. Kadar CRP berhubungan dengan kondisi inflamasi sistemik sehingga perlu dilakukan penelitian yang bersifat prospektip untuk menilai kadar CRP pasien PPOK dalam waktu tertentu atau dalam kondisi stabil dan diikuti berapa kali dia mengalami eksaserbasi untuk menilai kadar CRP berperan sebagai prognostik.

DAFTAR PUSTAKA

1. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J. Clin. Invest. 2003;111:1805–12.

2. Barnes PJ, Shapiro SD, Pauwels RA. Chronic obstructive pulmonary disease: molecular and cellular mechanisms. Eur Respir J 2003;22:672–88.

3. Barnes PJ. Medical progress: chronic obstructive pulmonary disease. N Engl J Med 2000;343:269–80.

4. Man SFP, Connett JE, Anthonisen NR, Wise RA, Tashkin DP, Sin DD. C- reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease. Thorax 2006;61:849–53.

5. Dahl M, Vestbo J, Lange P, Bojesen SE, Hansen AT, Nordestgaard BG. C- reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med.2007;175:250–5.

6. Torres JP, Cordoba-Lanus E, Lo´pez-Aguilar C, de Fuentes MM, de Gracini AM, Aguirre-Jaime A.C-reactive protein levels and clinically important predictive outcomes in stable COPD patients. Eur Respir J 2006; 27: 902–7. 7. Hurst JR, Donaldson GC, Perera WR, Wilkinson TM, Bilello JA, Hagan GW,

et al. Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006;174:867-74.

8. Perera WR, Hurst, Wilkinson T.M.A, Sapsford RJ, Mu¨llerova H, Donaldson GC. Inflammatory changes, recovery and recurrence at COPD exacerbation. Eur Respir J 2007; 29: 527–34.

9. Marevic S, Petrik J, Nada J, Grle S, Grubi T, Ivana. TNF-á, CXCL8, big ET-1 and hsCRP in patients with chronic obstructive pulmonary disease. Croatica Chemica Acta Ccacaa 2008;81: 211-7.

10.Sembiring SP. Hubungan antara kadar C-reactive protein dengan derajat keparahan pada PPOK stabil. Tesis. Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara. Medan.2007.

11.Parhusip D.H. Kadar C-reactive protein pada pemderita PPOK eksaserbasi. Tesis. Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara. Medan. 2007.

12.Durme YM, Verhamme KM, Aarnoudse AJ, Pottelberge GR, Hofman A, Witteman JC, et al. C-reactive protein levels, haplotypes, and the risk of incident chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;179:375–82.

13.Alavi SA, Soati F, Forghanparast K, Amani H. HsCRP in patients with acute exacerbation of chronic obstructive pulmonary disease. Iran Red Crescent Med J 2011; 13:713-8.

14.Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. Global Strategy for Chronic Obstructive Lung Disease (GOLD); 2013.

15.Suradi. Pengaruh rokok pada penyakit paru obstruksi kronik (PPOK) tinjauan patogenesis, klinis dan sosial. Pidato pengukuhan guru besar. Departemen Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Sebelas Maret. Surakarta. 2007.

16.Raherison C, Girodet PO. Epidemiology of COPD. Eur Respir Rev 2009; 18: 114, 213–21.

17.Purba M.Y. Profil penderita yang didiagnosa sebagai penyakit paru obstruksi kronik di Rumah Sakit Umum Pusat Haji Adam Malik Medan, Rumah Sakit Umum Tembakau Deli Medan dan Rumah Sakit Umum Pirngadi Medan tahun 2010. Tesis. Departemen Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Sumatera Utara. Medan. 2010.

18.Cosio MG, Saetta M, Agusti A. Immunologic aspects of chronic obstructive pulmonary disease. N Engl J Med 2009; 360:2445-54.

19.Young R.P, Hopkins R, Eaton T.E. Pharmacological actions of statins. Eur Respir Rev 2009; 18: 114, 222–32.

20.Chung K.F, Adcock IM. Multifaceted mechanisms in COPD: inflammation, immunity, and tissue repair and destruction. Eur Respir J. 2008; 31:1334–56. 21.Stockley R, Rennard SI, Rabe K, Celli B. Chronic obstructive pulmonary

disease. Australia. Blackwell Publishing Ltd. 2007.

22.Yoshida T, Tuder RM. Pathobiology of cigarette smoke-induced chronic obstructive pulmonary disease. Physiol Rev. 2007;87:1047–82.

23.Barnes PJ. Chronic obstructive pulmonary disease: effects beyond the Lungs. PLoS Med 2010;7:1-4.

24.Lusuardi M, Garuti G, Massobrio M, Spagnolatti L, Bendinelli S. Hearts and lungs in COPD: close friends in real life - separate in daily medical practice? Monaldi Arch Chest Dis. 2008;69:11-7.

25.Turato G, Zuin R, Saettaa M. Pathogenesis and pathology of COPD. Respiration. 2001;68:117–28.

26.Blackler L, Jones C, Mooney C. Managing chronic obstructive pulmonary disease. England. John Wiley & Sons Ltd. 2007.

27.Perhimpunan Dokter Paru Indonesia. Penyakit paru obstruksi kronik, pedoman praktis diagnosis dan penatalaksanaan di Indonesia. Jakarta: Indah offiset citra grafika; 2011.1-86.

28.Kohnlein T, Welte T. Alpha-1 antitrypsin deficiency: pathogenesis, clinical presentation, diagnosis, and treatment. American Journal of Medicine. 2008; 121:3-9.

29.Thompson D, Pepys M.B, Wood S.P. The physiological structure of human C- reactive protein and its complex with phosphocholine. Structure.1999;7:169– 77.

30.Kao PC, Shiesh SC, Wu TJ. Serum C-reactive protein as a marker for wellness assessment. Annals of Clinical & Laboratory Science. 2006;36.163-9.

31.Ballou SP, Cleveland RP. Binding of human C-reactive protein to monocytes: analysis by flow cytometry. Clin. exp. Immunol. 1991;84:329-35.

32.Prestegard E. The future of point of care testing using c-reactive protein an ideal tool for diagnosis, prognosis dan therapy management. Eropean endocrine review. 2006.

33.Nakou ES, Liberopoulos EN, Milionis HJ, Elisaf MS. The role of c-reactive protein in atherosclerotic cardiovascular disease: an overview. Current vascular pharmacology. 2008;6:258-70.

34.Gan WQ, Man SFP, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systemic review and a meta analysis. Thorax. 2004;59:574-80.

35.Olafsdottir IS, Gislason T, Thjodleifsson B, Olafsson I, Gislaon D, Jogi R, et al. Gender differences in the association between c-reactive protein, lung function impairment, and COPD. International journal of COPD. 2007;2:635- 42.

36.Olafsdottir IS. Inflammatory markers, respiratory disease, lung fuction and associated gender differences. Dissertation. Faculty of medicine Uppsala university. Swedish. 2011

37.Rothkrantz-Kos S, Schmitz MPJ, Bekers O, Menheere PPCA, Dieijen-Visser. High-sensitivity c- reactive protein methods examined. Clinical chemistry. 2002;48:359-62.

38.Vigushin DM,Pepys MB,Hawkins PN. Metabolic and Scintigraphic Studies of Radioiodinated Human C-reactive Protein in Health and Disease. J. Clin. Invest. 1993;91:1351-7.

39.Broz BR, Orden EA, Porras ML, Calero C, Coronilla FS, Blanco A, et al. Lung tissue expression of acute phase reactants in COPD. Am J Respir Crit Care Med 2010; 181:A2896.

40.Hutchinson WL, Koenig W, Frohlich M, Sund M, Lowe GDO, Pepys MB. Immunoradiometric assay of circulating c-reactive protein: age- related values in the adult general population. Clinical Chemistry. 2000; 46: 934-8.

41.Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. International Journal of COPD 2011:6;157–69. 42.Halvani A, Nadooshan HH, Shoraki FK, Nasiriani K. Serum C-reactive

protein level in copd patients and normal population. Tanaffos 2007;6:51-5. 43.Bircan A, Gokirmak M, Kilic O, Ozturk O, Akkaya A. C-reactive protein

levels in patients with chronic obstructive pulmonary disease: role of infection. Med Princ Pract 2008;17:202–8.

44.Broekhuizen R, Wouters EF, Creutzberg EC, schools AMWJ. Raised CRP levels mark metabolic and functional impairment in advanced COPD. Thorax 2006;61:17-22.

45.Wang Z, Hoy W. Population distribution of high sensitivity c-reactive protein values in aboriginal Australians: a comparison with other populations. J.clinbiochem.2005;11:1-7.

46.Sin DD, Lacy P, York E. Effects of fluticasone on systematic markers of inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170:760-5.

47.Pinto-Plata VM, Mullerova H, Toso JF, Feudjo-Tepie M, Soriano JB, Vessey RS, et al. C-reactive protein in patients with COPD, control smokers and non- smokers. Thorax 2006;61:23-8.

48.Karadag F, Kirdar S, Karul AB, Ceylan E. The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. European Journal of Internal Medicine 2008;19:104–8.

49. Kherad O, Kaiser L, Bridevaux PO, Sarasin F, Thomas Y, Janssens JP, et al. Upper respiratory viral infection, biomarkers, and COPD exacerbations. Chest 2010;138:896-904.

50. Roche Diagnostics. Cobas Integra Cardiac C-Reactive Protein (Latex) High Sensitive (CRPHS). 2010;6:1-11.

51. Sajal D. Body Mass Index Among Patient With Chronic Obstructive Pulmonary Diseases. Indian J Physiol Pharmacol 2012; 56(456(4):353–8. 52. Bihar S. Korelasi derajat obstruksi dengan transpor mukosiliar hidung

penderita penyakit paru obstruksi kronik stabil di rumah sakit umum pusat haji adam malik medan dan BP4 medan tahun 2012. Tesis. Departemen Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Sumatera Utara. Medan. 2012.

53. Battaglia S, Spatafora M, Paglino G, Pedone C, Corsonello A, Scichilone N, et al. Ageing and COPD affect different domains of nutritional status: the ECCE study. Eur Respir J 2011; 37: 1340–5.

54. Ohno Y, Koyama H, Nogami M, Takenaka D, Matsumoto S, Obara M et al. Dynamic oxygen-enhanced MRI versus quantitative CT: pulmonary functional loss assessment and clinical stage classification of smoking-related COPD.AJR 2008; 190:93–9. 55. Nugraha I. Hubungan derajat berat merokok berdasarkan indeks brinkman

dengan derajat berat PPOK. tahun 2010. Penelitian. Akper Patria Husada Surakarta. Surakarta. 2010.

56. Yang L, Zhou M, Smith M, et al. Body mass index and chronic obstructive pulmonary disease-related mortality: a nationally representative prospective study of 220 000 men in China. Int J Epidemiol2010; 39: 1027–36.

57. Takemura H, Hida W, Sasaki T, Sugawara T, Sen T. Prevalence of chronic obstructive pulmonary disease in Japanese people on medical check-up. Tohoku J. Exp. Med. 2005; 207: 41-50.

58. Kojima S, Sakakibara H, Motani S, Hirose K, Mizuno F, Ito M. Effects of Smoking and Age on Chronic Obstructive Pulmonary Disease in Japan. J Epidemiol 2005; 15:113-7.

59.Nurdin K. perbandingan kadar CRP pasien PPOK stabil dengan orang sehat yang perokok di Rumah Sakit Umum Pusat Haji Adam Malik Medan. Tesis. Departemen Pulmonologi dan Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Sumatera Utara. Medan. 2013.

60.Miravitlles M, Garcia P, Fernandez A, Buendia MJ, Monteros MJ, Molina J, et al. Course of COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores during recovery from exacerbations of chronic obstructive pulmonary disease. Health and Quality of Life Outcomes 2013, 11:147.

61.Agustí A, Soler JJ, Molina J, Muñoz MJ, García-Losa M, Roset M, et al. Is the CAT questionnaire sensitive to changes in health status in patients with severe COPD exacerbations? COPD 2012; 9:492–8.

62. Jones PW, Brusselle G, Negro RW, Ferrer M, Kardos P, Levy ML et al. Properties of the COPD assessment test in a cross-sectional European study. Eur Respir J 2011; 38: 29–35.

Dokumen terkait