Peran N-Acetylcysteine terhadap Hepatotoksisitas pada Penderita Tuberkulosis Paru Terapi Obat Antituberkulosis

Oleh :
Rudi Satriawan - S6006003 - Fak. Kedokteran

BACKGROUND: Isoniazid, rifampicin and pyrazinamide are essential components of the strategy directly observed treatment short-course (DOTS) for tuberculosis control adopted by the World Health Organization (WHO) and all three have the potential hepatotoxic. Some studies conclude N-acetylcysteine (NAC) protects against drug-induced hepatitis induced by combination treatment isoniazid, rifampicin and pyrazinamide. Hepatoprotection of NAC may be by acting as a glutathione synthesis. The purpose of this study was to determine the role of NAC against on hepatotoxicity antituberculosis drug therapy in patients with pulmonary tuberculosis. METHODS: This type of research is experimental study, with takes the subject of 60 patients with pulmonary tuberculosis of new cases that met inclusion and exclusion criteria in Dr. Moewardi hospital, BKPM Klaten, and health centers throughout the city of Surakarta in May-June 2012. The subjects were divided into control group (n = 30) who received therapy for rifampicin, isoniazid, pyrazinamide, and ethambutol, and the treatment group (n = 30) received the same therapy plus NAC. All the subjects conducted follow-up for 14 days. Examination of serum levels of aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), and total glutathione were done before treatment and day 15 of therapy, also if the patient shows clinical symptoms of hepatotoxicity. RESULTS: Mean total glutathione levels in the control group before therapy increased from 118.64 ± 68.78 to 228.74 ± 179.01 after 14 days therapy. Mean total glutathione levels in the treatment group before treatment rose from 145.54 ± 90.46 to 418.98 ± 174.35 after 14 days therapy. Both were statistically significant in both treatment groups and control group (p = 0.000). Mean AST in the control group increased from 24.27 ± 8.88 to 39.70 ± 56.48 after 14 days therapy. Mean AST levels in the treatment group increased from 20.97 ± 5.09 to 21.50 ± 11.75 after 14 days therapy. Mean AST levels were not statistically significantly different both in the control group (p = 0.131), as well as the treatment group (p = 0.796). Mean ALT levels in the control group before therapy 19.67 ± 8.87 increased to 41,67 ± 58.87 after 14 days therapy. They were statistically differed significant (p = 0.042). Mean ALT levels in the treated group decreased from 19.73 ± 12.71 to 17.37 ± 14.89 after 14 days therapy. They were statistically differ not significant (p = 0.316). CONCLUSION: Administration of NAC contributed to the increase of total glutathione levels in patients with pulmonary tuberculosis who received antituberculosis drugs therapy.