Efek Imunoterapi, Probiotik, Nigella Sativa Terhadap Rasio Cd4+
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Efek Imunoterapi, Probiotik, Nigella Sativa Terhadap Rasio Cd4+/Cd8+, Imunoglobulin E dan Skoring Asma Hittoh Fattory 1, Agustina Tri Endharti2, Wisnu Barlianto3, Ery Olivianto4, HMS Chandra Kusuma4 1 Program Studi Magister Biomedik/Program Studi Pendidikan Dokter Spesialis Anak, Fakultas Kedokteran Universitas Brawijaya/Rumah Sakit dr. Saiful Anwar Malang, Indonesia 2 3 Departemen Parasitologi, Fakultas Kedokteran Universitas Brawijaya Malang, Indonesia Divisi Alergi-Imunologi-Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Brawijaya/Rumah Sakit dr.Saiful Anwar Malang, Indonesia 4 Divisi Respirologi-Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Brawijaya/Rumah Sakit dr. Saiful Anwar Malang, Indonesia ABSTRAK Imunoterapi alergen-spesifik dan reduksi alergen merupakan intervensi pada penyakit alergi dan berpotensi untuk mengurangi gejala alergi jangka panjang. Penurunan sel T CD4+ dan CD8+ type 2 berkorelasi erat dengan mekanisme regulasi dari imunoterapi. Sejauh ini belum ada penelitian yang mengkaji pemberian jangka panjang imunoterapi, probiotik dan Nigella sativa terhadap modulasi respon imun, khususnya rasio sel T CD4+/CD8+, imunoglobulin E (IgE) dan skoring asma. Desain penelitian berupa eksperimental randomized clinical trial (RCT), pre-post control study untuk rasio sel T CD4+/CD8+, IgE dan skoring asma. Subyek dibagi 4 kelompok, imunoterapi+plasebo, imunoterapi+Nigella sativa, imunoterapi+probiotik, imunoterapi+Nigella sativa+probiotik, diberikan perlakuan 56 minggu. Imunoterapi yang digunakan adalah imunoterapi house dust mite subkutan. Probiotik yang diberikan ProBi (Medifarma) berisi 2x109 colony forming unit(cfu)/gram Lactobacillus acidophilus dan Bifidobacterium lactis. Skoring asma dinilai dengan skor Asthma Control Test. Rasio sel T CD4+/CD8+ diukur dengan flowcytometry, untuk IgE diukur menggunakan Chemiluminescence Enzyme Immunoassay. Hasil penelitian menunjukkan rasio sel T CD4+/CD8+ meningkat bermakna antara sebelum dan setelah perlakuan pada kelompok imunoterapi+Nigella sativa (p=0.027), imunoterapi+probiotik (p=0,001), dan imunoterapi+Nigella sativa+probiotik (p=0.046). Kadar IgE tidak berbeda bermakna antar kelompok antara sebelum dan setelah perlakuan. Skoring asma meningkat bermakna antara sebelum dan setelah perlakuan pada kelompok imunoterapi+Nigella sativa (p=0.002), imunoterapi+probiotik (p=0,000), dan imunoterapi+Nigella sativa+probiotik (p=0.000). Sebagai kesimpulan, pemberian imunoterapi+Nigella sativa+probiotik meningkatkan rasio sel T CD4+/CD8+ lebih tinggi bermakna dibandingkan imunoterapi saja. Pemberian imunoterapi+Nigella sativa+probiotik menurunkan kadar IgE lebih rendah tidak bermakna dibandingkan imunoterapi saja. Pemberian kombinasi imunoterapi+probiotik meningkatkan skoring asma lebih baik dibandingkan imunoterapi saja. Kata Kunci: imunoterapi, probiotik, Nigella sativa, rasio sel T CD4+/CD8+, imunoglobulin E, skoring asma Effect of Probiotic, Nigella Sativa and Immunotherapy in Ratio Cd4+/Cd8+, IgE and Asthma Scoring ABSTRACT Allergen-specific immunotherapy and allergen reduction is an intervention in allergic disease and has potential to reduce long-term allergy symptoms. Decrease of type 2 CD4+ and CD8+ T cells correlates with regulatory mechanisms of immunotherapy. There was no study to evaluation the longterm administration of immunotherapy, probiotics and Nigella sativa on modulation of the immune response, specially the CD4+/CD8+ T cells ratio, immunoglobulin E (IgE) and asthma scoring. The research design was randomized clinical trials (RCTs), pre-post-control study. The subjects were divided into four groups, immunotherapy+placebo, immunotherapy+Nigella sativa, immunotherapy+probiotics, immunotherapy+Nigella sativa+probiotics given in 56 weeks. We used house dust mite (HMD) subcutaneous immunotherapy, Probi (Medifarma) which contain 2x109 colony forming unit(cfu)/gram Lactobacillus acidophilus and Bifidobacterium lactis and asthma control test (ACT) as asthma scoring method. Scoring asthma assessed with the Asthma Control Test scores. The CD4+/CD8+ T cells ratio was measured by flowcytometry, for IgE was measured using Chemiluminescence Enzyme Immunoassay. The results showed the CD4+/CD8+ T cells ratio increased significantly before and after treatment in the group immunotherapy+Nigella sativa (p=0.027), immunotherapy+probiotic (p= 0.001), and immunotherapy+Nigella sativa+probiotic (p=0.046). There were no significant differences in the IgE level before and after treatment. Asthma scoring increased significantly before and after treatment in the immunotherapy +Nigella sativa (p=0.002), immunotherapy+probiotic (p=0.000), and immunotherapy+Nigella sativa+probiotic (p=0.000) group. Conclusion, Immunotherapy+Nigella sativa+probiotic had increased CD4+/CD8+ T cells ratio than immunotherapy alone. Immunotherapy+Nigella sativa+probiotic had decreased IgE than immunotherapy alone. Combination immunotherapy+probiotic had increased asthma scoring greater than immunotherapy alone. Keywords: immunotherapy, probiotics, Nigella sativa, CD4+/CD8+ T cells ratio, immunoglobulin E, scoring asthma Korespondensi: Hittoh Fattory. Laboratorium Ilmu Kesehatan Anak Rumah Sakit Umum Dr.Saiful Anwar Malang, Jalan [email protected] Jaksa Agung Suprapto 2 Malang, Telp (0341) 366242 Email: