Intiisari

PENGARUH PEMBERIAN ERDOSTEINE

TERHADAP KADAR C-REACTIVE PROTEIN SERUM
PENDERITA PENYAKIT PARU OBSTRUKSI KRONIK STABIL

Lina Tjandra, Eko Budiono*, Neneng Ratnasari*

*Bagian/SMF Ilmu Penyakit Dalam
Fakultas Kedokteran UGM/RSUP Dr. Sardjito
Yogyakarta

Latar Belakang : Inflamasi sistemik terbukti berkontribusi dalam

patogenesis kelainan paru, kelainan ekstraparu, serta merupakan faktor resiko
independen eksaserbasi penyakit paru obstruksi kronik (PPOK). Erdosteine
merupakan suatu agen mukolitik yang memiliki kemampuan menghambat
reactive oxygen spesies (ROS) dan eicosanoid yang terlibat dalam stres oksidatif
dan proses inflamasi. Penelitian ini bertujuan mengetahui efek pemberian
erdosteine terhadap kadar C-reactive protein (CRP) serum penderita PPOK stabil.
Metode : Penelitian ini merupakan randomized controlled trial yang
menilai pengaruh penambahan terapi erdosteine 2x300 mg selama 10 hari
dibandingkan plasebo terhadap kadar CRP serum penderita PPOK stabil yang
mendapatkan terapi standar. Subjek direkrut dari pasien PPOK yang berobat di
Poliklinik RSKP Respira Yogyakarta. Diagnosis PPPOK ditegakkan secara klinis,
rontgen torak, dan spirometri. Pemeriksaan kadar hs-CRP serum diukur saat awal
dan hari ke-11 dengan menggunakan metode immunometric assay.
Hasil : Tiga puluh lima subyek mengikuti penelitian sampai akhir (97,1%
laki-laki, rentang usia 40-77 tahun, median FEV1 0,83 (0,50-10,08) L, hs-CRP
serum 0,84 (0,18-18) mg/L), 19 orang kelompok pada erdosteine dan 16 orang
pada kelompok plasebo. Tidak terdapat perbedaan karakteristik dasar pada kedua
kelompok. Median penurunan kadar hs-CRP pada kelompok erdosteine dan
plasebo berturut-turut adalah -0,10 (-16,16-+4,31) vs 0,005 (-11,7-+11,03) mg/L,
p 0,275. Subanalisa subyek penelitian PPOK GOLD 3, median penurunan hs-CRP
serum kelompok erdosteine lebih besar dibanding plasebo (-0,56 (-16,16-+0,44)
vs 0,11 (-11,7- +11,03) mg/; p 0,03). Adanya peningkatan stres oksidatif seiring
peningkatan derajat keparahan PPOK diduga menyebabkan efek antioksidan
erdosteine lebih nyata yang berakibat pada penurunan kadar CRP serum yang
lebih besar.
Kesimpulan : pemberian erdosteine 2x300 mg selama 10 hari pada
penderita PPOK stabil menurunkan kadar CRP serum secara statistik tidak
bermakna dibandingkan plasebo.

Kata kunci : PPOK stabil, C-reactive protein, erdosteine, FEV1, GOLD

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 ABSTRACT

EFFECTS OF ERDOSTEINE ADMINISTRATION ON

SERUM C-REACTIVE PROTEIN LEVEL
IN STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE
PATIENTS

Lina Tjandra, Eko Budiono*, Neneng Ratnasari*

*Department of Internal Medicine School of Medicine
Gadjah Mada University/Sardjito General Hospital
Yogyakarta

Its been proven that systemic inflammation contributes to the

development of intra and extra pulmonary disorders, and is an independent risk
factor for exaxerbation of chronic obstructive pulmonary disease (COPD). The
use of corticosteroids as anti-inflammatory agents has limitation for their
undesirable side effects and different efficacy among the patients. Erdosteine, a
mucolytic agent widely used in COPD, has been proven to be able to inhibit
several mediators such as reactive oxygen species (ROS) and eicosanoids, which
are involved in oxydative stress and inflammation. This study is aimed to discover
the effects of erdosteine administration in serum C-Reactive Proteine (CRP) level
in stable COPD patients.
Methods: The research is a randomized controlled trial, which comparing
add-on therapy using erdostein 300 mg bid versus plasebo, for 10 days, combined
with COPD standard treatments. Patients are recruited at RSKP Respira
Yogyakarta outpatient clinics. Diagnosis are confirmed using spirometri based on
GOLD criteria. Evaluation of CRP levels are held before treatment and on the
eleventh day, using high sensitive quantitative immunometric assay.
Result: There 35 subjects (97,1% men, age range 40-77 years, median
FEV1 0,83 (0,50-10,08) L, hs-CRP 0,84 (0,18-18) mg/L) who completed the
study, 19 subjects in erdosteine and 16 subjects in plasebo group. Baseline
characteristics were similar between two groups. There were no significant
decreases in median hs-CRP level in erdosteine vs plasebo group at day 11 (-0,10
(-16,16-+4,31) vs 0,005 (-11,7-+11,03) mg/L; p 0,275). In COPD GOLD 3
subpopulation, hs-CRP serum level decline was greater in erdosteine group
compared to placebo (-0,56 (-16,16-+0,44) vs 0,11 (-11,7- +11,03) mgL/; p 0,03)
this might be related to greater oxidative stress in severe COPD that makes
antioxidative effects of erdosteine reduce CRP more significantly in severe
COPD.
Conclusion: Effects of erdosteine supplemenets, 300 mg bid for 10 day,
could decreases hs-CRP level in erdosteine unsignificantly compared to placebo.

Key words: stable COPD, C-reactive protein, erdosteine, FEV1, GOLD

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