KETEBALAN DAN KERAPATAN KOLAGEN PADA PENDERITA FILARIASIS KRONIS DENGAN LIMFEDEMA STADIUM II

Abstract

Abstract

Concern have been expressed on the deleterious effects (aesthetic, mobility, work productivity and economic) due to lymphedema in chronic lymphatic filariasis. Advanced stage of lymphedema is permanent in nature due to irreversible lymph system fibrosis which leads to progressive fibrogenesis in the surrounding tissues. In 3rd stage lymphedema of chronic filariasis, a high volume increase occurred on extremities followed by dermis and subcutis alteration.  Present method of management to solve this condition, however, appears to be unsatisfaction. There is need to search for more effective method to decrease fibrosis in 3rd stage lymphedema of chronic filariasis. Low Dose Laser (LDL) have been experimentally studied to decrease tissue fibrosis in many diseases, but none in lymphatic filariasis. This study attempt to analyze the role of LDL on fibrosis process by observing epidermis thickness, basal membrane collagen thickness, and dermis collagen density in 3rd stage lymphedema of chronic filariasis . This is a quasi- experimental research using pre- and post test with control design. Of the 20 cases involved in this study, the control group was given WHO standard lymphedema management whereas the treatment group was given the same management plus LDL in specified accupoints. To observe the difference between treatment and control group, this study uses Independent T Test for normal distribution ratio data at a significant level of 5%, or Mann-Whitney Test for unequal distribution ratio data or ordinal data. This study showed 18.33 μm decrease of median epidermis thickness in treatment group and  6.67 μm  increase  in control group (p ITT=0.165, p perprotocol=0.034). There was 2.5 μm decrease of basal membrane collagen thickness in treatment group and  15 μm decrease in control group (p=0.027). We found 4 point increase of   dermis collagen density score in treatment group  and 0.5 point increase in control group (p=0.190). LDL decrease epidermis thickness, decrease basal membrane collagen thickness, doesn't decrease dermis collagen density. However, LDL inhibit the progression of dermis collagen density.

Key words:  chronic  filariasis, lymphedema, Low Dose Laser, fibrosis, epidermis, collagen.