Ekspresi Cyclooxygenase-2 (COX-2) pada Penderita Rinosinusitis Kronis di RSUP H. Adam Malik Medan

Abstract

Introduction: Chronic rhinosinusitis is an inflammation of the nasal mucosa and paranasal sinuses which are closely related to the involvement of ostiomeatal complex or the narrow space of the etmoid in front of the anterior part of maxillary and frontal sinuses. If there is an interference with areas such as inflammation or edema to the ostiomeatal complex then it would cause drainage problems leading to rhinosinusitis . Increased expression of COX-2 regulation estimated to play an important role as a mediator in the development of chronic rhinosinusitis and increased airway inflammation in the nasal mucosa and paranasal sinuses. Aim: Acknowledging the expression of Cyclooxygenase-2 in patients with chronic rhinosinusitis in H. Adam Malik General Hospital, Medan. Methods: This descriptive research was conducted at the Otorhinolaryngology Head and Neck Surgery Department and Pathology Anatomy Department of Medical Faculty of Sumatera Utara University/H. Adam Malik General Hospital, Medan. The research was conducted from July 2011 to December 2011 on all patients diagnosed with chronic rhinosinusitis, who underwent sinus surgery from July 2011 to December 2011 Results: The highest proportion of patients with chronic rhinosinusitis were in the adolescent age group of 19-29 years 35.7%, with the proportion of men 64.3% and women 35.7%. The most complaints are nasal congestion by 57.1%. The highest proportion of pain in patients with chronic rhinosinusitis is facial pain/pressure and headache with nasal congestion by 78.6%. Multi sinusitis on CT scan SPN by 88.0%. The proportion of COX-2 expression is the highest expression of COX-2 positive by 84.0%. There is a significant difference in proportion between the number of sinuses involved with the expression of COX-2 (p = 0.002). There was no significant difference in proportions between the sexes and in the expression of COX-2 (p = 0.604). There were no significant difference in proportions between age groups with the expression of COX-2 (p = 0.857). There were significant differences between the proportion of pain with the expression of COX-2 (p = 0.033). Conclusion: COX-2 is the key to the pathophysiological processes of inflammation and the upregulation of COX-2 expression is thought to play a role as a mediator in the development of chronic rhinosinusitis Key words: chronic rhinosinusitis, ostiomeatal complex, cyclooxygenase-2, immunohistochemical patient characteristics.

Pendahuluan: Rinosinusitis kronis merupakan peradangan mukosa hidung dan sinus paranasal yang erat hubungannya dengan keterlibatan kompleks ostiomeatal atau celah sempit di etmoid anterior yang merupakan serambi muka bagi sinus maksila dan frontal. Bila terdapat gangguan didaerah kompleks ostiomeatal seperti inflamasi atau edema maka hal itu akan menyebabkan gangguan drainase sehingga terjadi rinosinusitis. Peningkatan regulasi ekspresi COX-2 diperkirakan memegang peran penting sebagai mediator dalam terjadinya rinosinusitis kronis dan peningkatan inflamasi saluran napas di mukosa hidung dan sinus paranasal Tujuan Penelitian: Mengetahui Ekspresi Cyclooxygenase-2 pada penderita Rinosinusitis Kronis di RSUP H. Adam malik, Medan. . Metode: Penelitian ini bersifat deskiptif dilakukan di Departemen THT-KL FK USU/RSUP H. Adam Malik, Medan dan Departemen Patologi Anatomi FK USU. Penelitian dilakukan mulai bulan Juli sampai dengan Desember 2011 pada seluruh penderita yang didiagnosis rinosinusitis kronis, yang menjalani operasi sinus di divisi Rinologi Departemen THT-KL FK USU/RSUP H. Adam Malik, Medan sejak bulan Juli 2011 sampai dengan Desember 2011. Hasil Penelitian: Proporsi penderita rinosinusitis kronis tertinggi pada kelompok umur dewasa muda 19-29 tahun 35,7%, dengan proporsi laki-laki 64,3% dan perempuan 35,7%, keluhan terbanyak adalah hidung tersumbat 57,1%, proporsi rasa nyeri terbanyak pada penderita rinosinusitis kronis adalah nyeri/ tekan wajah, sakit kepala dengan hidung tersumbat 78,6%, multi sinusitis pada pemeriksaan CT Scan SPN 88,0%, proporsi ekspresi COX-2 terbanyak adalah ekpresi COX-2 positif sebanyak 84,0%. Ada perbedaan proporsi yang bermakna antara jumlah sinus yang terlibat dengan ekspresi COX-2 (p = 0,002). Tidak ada perbedaan proporsi yang bermakna antara jenis kelamin dengan ekspresi COX-2 (p = 0,604). Tidak ada perbedaan proporsi yang bermakna antara kelompok umur ekspresi COX-2 (p = 0,857). Ada perbedaan yang bermakna antara proporsi rasa nyeri dengan ekspresi COX-2 (p=0,033). Kesimpulan: COX-2 merupakan kunci proses patofisiologi inflamasi rasa nyeri, peningkatan regulasi ekspresi COX-2 diperkirakan berperan sebagai mediator dalam terjadinya rinosinusitis kronis. Kata Kunci: rinosinusitis kronis, kompleks ostiomeatal, cyclooxygenase-2, imunohistokimia, karakteristik penderita.