Universitas Sumatera Utara

Transkripsi

1 5 AB II B INJAUAN USTAKA T 1 2 Kro ru Orukf yk 11 2 f D () kro oukf ru yk lh krok ru yk rogrf rf lur ur lr hm olh mfm y rl rvrl u orvrl muru Sgk 2003) (DI, kro rok I lol G Chroc for v D Lug rucv O h l 2013), GOLD, ( ru yk o, cgh r ur lr lm jl krok flm ro k rogrf, m rk ru u g k komor Ekr rcu rkl yk ry rkoru 12 2 olog E kro, orukf ru yk y mj hl Byk yu: ry 1 k roko M y mruk m k hw myuk l 90% mc m kr Kj rjy ryk mkrofg mmgruh gr M 2013) (Mofr, ku k l, kmokk fkor lk m kruk myk gr, 15% rkmg gfk, Scr jrg m, mmul U ry l uk jumlh wluu morl mmrk m u rhu, ugku umlh j Uvr Sumr Ur

2 6 Sumr: Br, 2006 Gmr 21 uru FEV1 Org m mglm uru FEV1 : cr folog orml, uru FEV1rkrk kr ml/hu, y muru 60 ml/hu u lh r Su lkuk Nglm ruh o ruk l (2011), rukurl 2 F kor Lgkug Muru ru mymulk uh mucul (Mofr, 2013) Nglm mucul hw gggu fug lum ru kl l (2011) lm Mofr (2013), jug rj vu k rh m Wluu r olu ur g olog k jl, fky lh kcl l gk m gr rkmg, ggu h kr om r mmk yumg rr 3 H rof jl mmk lm rug lm rvl kmugk jug mj jug mmlk kcrug y hrof jl, r m T m r- r r Am lh g fom lrg, gk mruk hl r kruk Uvr Sumr Ur

3 7 kk mmgk logul Su kr rg fug uru mglm kmu u wl lur mujukk lh ru cr lur kk gk hw (Rlly, mg wku ru fug uru rkor mruk jl lum jl mh u T 010) 2 4 Alf f D - ) (AAT r 1 lf A -1- ro frk u lh mruk r rum rofl l mrlr lkrofor mllu hk lol ghcur r ru mlug hgg ru rum rlug mkm mk f, k 2013) (Mofr, l rh myk hgg rkurg, ol AAT f hw myk 1963 hu Erko mfml uooml cr wrk - myk k koom (Am, AAT g mu kr k AAT Df mfm 1 96) 9 5 Imuof rom S Lmrch uru M l fk (2013), Mofr lm (2011) Hum vru mmuofccy hk, rko fkor mruk (HIV) r IV, o m, r ggggu vrl mgorol lh u fk uomu f cr umocy rj kl korkl ru ruk k 6 Ik Jrg ggu G rum gmrk l gggu lh lx Cu kogl y yk rmur u rmcm uk g huugk rkok Emfm rf) om, (m uru lx u c yk og y u ou ro r jk yk yu Srom Mrf rool u l fk kr uooml om y 10% kr muk I, kolg 2013) (Mofr, mfm rmuk ru, orml glm m Uvr Sumr Ur

4 og og og mkm rg kr rj lh: ry rjy 1 ro o H - ro ho (2013), Vjy lm (1963) Erko Lurll Muru ro - jrg kruk hw um rk ro hory ro kkmg kr rj mfm T lk zm gr ku gk hw yk lh uulk Ko mfm hory gk f AAT f gmrk mfm Mu AAT g mu mglm AT A umum lg mu Z lh Hly ho r ro kr mgggu mu Dlork rkul ro r ghm lvl uru Z hw - mghm olmr mglm AT crug α1 kr myk rofl l h mgggu hk, 2005) Igo, (Shro flm mlloro rx M h mml kmmu mmlk (MM) lm rr hgg l, kolg r rukurl ro og yk gk Mlloro rx M lork (MM MM 3 kr mfm -, 2 - mgr 12) 9, g rr l ro 1981) Dvo, (Hughk l ( L S, ch lh og lm G, mkrofg), lm ro r ) (Shro, (lmrofl) 3 2 Imuolog km M rh orml ru flm ro rhuug Brr 2011)Muru (GOLD, rum rhy, g u rkl l l (2012) mglm lork (2013), m Vjy ru jrg uum, rofl gk lvg rocholvolr rum Lvl og lm g rr urofl (BAL) Uvr Sumr Ur

5 9 mmuogloul fr lgh ch ( IgLC) mgk kr IgLC mgk gk rofl rouk IL8 cro-l kg IgLC rofl mghlk mruk rk lkf M uru Chuh l ( 1990) lm Dol (2013), l B l jug rofl mgk mmrouk IgCL, l mmrouk IgG IgA Lvl rum IgE jug mgk rhuug m ( Sgh l, 2010) 3 Kmg Ok- ok Sr okf mgggu vol rumuh l ol (Vjy, 2013) Kk ok mlh ok ru; mofk ro, lmk, O k mlh krohr, DNA rj mghlk ru mmofk l, hgg lh roolk M mgkv kruk h o r jrg rh cyl ( HDAC2) myk rkr kmok/ok rofl (TNF- α IL- 8) MM ruky mfm 4 I flm Smk hgg rj gr mrk mukug jug mmlk mf krulmoml Dyk hw flm ulmol r myk l kmok ok ro- flm umum k rkul Mor mmul lvr, jrg o ulg mlk ( IL) -6, IL-8, frog TNF- α k mk (Tkc ( 2013) flm mk jumlh rkul luko, CR, myk rluk flm l, 2007) Muru Thom l (2012) lm Vjy mmul u mmruruk yk komor, r yk jug kmk, oooro, m ormok, k kr 5 A oo ru, r, ll (Vjy, 2013) Su rru myk hw oo rl lm rkmg lh ujukk y gk oo l lvolr l ol ru Kr k mg gk Uvr Sumr Ur

6 10 rolfr j rg ro rukurl, mk hl ru mfm (Vjy, 2013) 6 rk Tk Efkf k rkhr kruk A rk k fkf mfm kr kmmu ru w mmrk lvolu ruk (Vjy, 2013) 2 14 ofolog m km Gjl-g jl mulk olh mruk koku r ofolog, ry lh: 1 m Alr ur Ur Trjk Iflm lu, fro ku lum lur 1 r rhuug uru FEV1 ro FEV /FVC, O Dol oruk kcl mugk rc uru FEV1 ( krkrk ) (Hogg l, 2004) m yk lm k lur kr mghlk H rfl u m Lvz (2007) k lm GOLD mjk (2013) ur myk kr hw hrfl Emfm jug rr lm mjk ur rul Hrfl fugol gk rkmg kv 2 A orml rukr G mgurg mgk, h wl k khuuy kr yk r k lm mj mk Muru Rorguz- Ro McN( 1998) lm ATS- ERS orml Dru orml rukr g myk hokm jug kv, kv mkm (2004) hrk orml ro vl- rfu lh mkm rukr g Rorguz l (2009) lm GOLD (2013), myk hw umumy rfr okg kro ok mmuruk lm rjl yk Hl myk r kro ok komk uru vl lm krj r gg kr oruk r hrfl rm gggu r oo v l Uvr Sumr Ur

7 1 1 3 Muku rkr H r folog orml lh muku rkr H m Lm mmr muku kljr r kr mul lh wly - (ATS kumo l ml kr rj muku hrkr lm k - kro roukf uk mghlk muku Hrkr ERS 2004) h l jumlh gk rj l lh muku rkr umuko kljr mr ol g 4 l ulmo r H rj lh y lm, uh ku Trj myk rkoru Fkor g rukr orml h ol, fug vokork, rmuk ulmol r uu mugk Kom ulmol rr rmollg (ATS k jug vrkl mr yk m - A 2004) ERS, m rh muluh flm o r rj g hlgy Emfm lur llry c rkoru jug 2013) (GOLD, ulmol rkul gk k rjy 5 k Sm mr G fug mmgruh hrfl khuuy ur lr Kr (Brr g rukr ug j l rkul k flm Mor 2010), khk, kll oo m uru rkoru mugk mmr u mmul ugk m yk r komor yk uruk, ormok, m oooro, jug, ggl kmk, jug mk Efk 2013) (GOLD, r molk, rom kv k m rkoru mruruk m mrk ru fug rgug k rogo, ( om, 2006 Boz, ) 15 2 go D Uvr Sumr Ur

8 2 1 l, yk mgo r m mgo Dlm kl Dgo ujg mrk fk mrk m, yu OK hru kro uk, mglm rmgk yk rko fkor rj rwy rlh, uum rouk u kl kok lm go mmu uuhk romr Nl FEV l y A 1 FVC orokolor / m y mmk < ) mruk (GOLD, r ur lr 1 m A m rwy y mlh hl r yk m yu:, rhuug, rko rh fkor j u krj j, r gkug l l; ol u u, lrg, m, rmuk rhulu, m Rwy k rr fk - ly r yk k c kro r yk u klurg wy R ly w u rkmg y gjl: rkmg ol r kul gk k r kyk u mcr lum hu r ol kr r m go u kr wy R u rhul r yk kr w r f gggu oooro, jug, gggu komor: yk Ay m lm rr jug kg mukulokll, kv g krj khlg, khu lm yk mk D lm r fk koom, mk r klu u r, cm mr g, kul kv gggu r h k mroko rh mly rko, fkor muruk mugk K kluh gjl k k jug m lm D - kluh mk Gjl yky g - ry gjl lh: Uvr Sumr Ur

9 3 1 k u B rogrf cr wly, wl) (g r hy j Buk y kro Buk okurl jrg hr, jg ru k rg roukf r koku g gg g rj mugk uk kr ko frkur u uk Sko m ATS ( - ) 2004 RS, E m Suu rouk lm hr g rj mul uum S - mucul k klm muko rf Suum hr jg ru k rjumlh uum rouk r molog f lh hu lm 2 ul 3 mmr volum u uum (urul) wr ruh kro rok (ATS fku kr rj k - uum rouk 2004) ERS, vlu ul rg mly mmlh lh mugk kr uum mmrouk mmugy gk 2013) (GOLD, rokk yk mmlk mugk r umlh j c D S r mj wku rjl rg rogrf y B o, ll) uk, mk gg, (k kv rj gjl mgguk (m rlku ruh hr hk rkmg, yk lm Bgmu, lvor) rg kv lm mucul k S (AT rh u ) ERS, kcm kkmmu um y mj D yky rhuug lm k S D g M mugk fk k gjl mruk k Mg hr rvr r rl mugk rgr Mg r rl r, lm uh ku rg k D lrg oo omrk ork k ) (GOLD, rkol o o Br yk mr G m lh ork r uru lh, L um lh kr rj uk Sko r g r gjl Uvr Sumr Ur

10 4 1 jg jgk rg lm rorkl k r c gk ko frkur myk jug rh Buk uk mom y T - r ko - mujukk jug ulmol mglm k mugk u, Sl uruk yk k 2013) (GOLD, kcm gggu u r jl g 2 k F mrk k y mh fk mrk mujukk mucullh yk, rjl Srg 2003) (DI, kl gjl mj kh mk k lm mk gjl r m k gggu ru mmrk mk muu r r T k: I ch rrl, ur - g rh l r orml k grk, oo ggu /om - mruk Smu r oo r mk gggu hrfl ur, lr m (ATS r - ) 2004 RS, E l: ) 2003 (DI, mfm mlmh muk frmu rku: h hrfl, kr m ur frgm, lk uru (ATS r - ) 2004 RS, E ukul: A rok r mlmh, u orml, vkulr ur kr k, kr u r wku mg u 2003) (DI, juh jug rgr uy mjg, m k Sm T h mr lhr, v D r m fr rj rh fl lm u ulmol cor r k oo m hlg K r rf oo lmh k ko kl oo fug /u mlur g 3 g uj mrk lm k ujg mrk : lh go m ru rh mrk Uvr Sumr Ur

11 5 1 mrh rh l gk ll luko, H, H, l mlh Uuk (hokm) rh rh okg lvl kk rj (rroo), okg mmw mrh rh Sl lm wku lm rh ur cuku mmrolh k ru, kruk Kr mrh rh l rouk mgkk lh uuh rk Shgg 2010) (Huy, rh okg gkk jumlh m romr ru mrk fl mrk go l hl mruk ru fl rogry mmu mmu jug yk, krh l FVC, lh romr mrk r Nl EV F 1 /FVC EV1 F rmr kg r l uru FEV Nl ru fl lm gggu y ujukk m 1 g y guk rg lg k lh romr hl r k jug ry ml ur, lr oruk ml yk rjl mu m c R mrk olog k mmg rolog mrk mu lkuk Hru yk mygkrk lm mmu go, f Umum wluu umoork) lur, fu kkr, (umo, l mfm fk, k mr, frgm lh (ATS rgulr ru olu r - kro Brok 2004) ERS, kromgl rokovkulr gk rhuug ulmol, hr komlk Dg 2013) (Mofr, mj hlu kulr v mrr y kmugk rg, k rkulr v ) (AGDA Arr Drh G l A kku g ujuk mmrk rr rh g Al hokm mglm yk r kr krh h g g r hokm yk, rjl Srg rk ru Mkm rkmg mul hrk mmuruk Umumy ku kr lm mmuruk g rukr Uvr Sumr Ur

12 16 f mkm kom gjl rj hk CO2 k rorh lm uuh (rok); hgg H y mk orml g ggu By, E vlu Suum yk urofl l H wh 7,3 ku r m r (Mofr, 2013) rok Dg kro gk l, kr, jumlh uumy uum uum muko mj mruk urul mj mkrofg kr kr g y ku (Mofr, 2013) Br orgm rg muk r kulur lh S rococcu umo Hmohlu fluz Morxll c rrhl jug rg, uomo rugo muk oruk r mrk Alf-1 Ar u mwkl gk Hl loku AAT rh, lkuk ll go umum ffy foku ll olkr M olculr goyg D NA lkuk ll l mmuuhk rum jrg umum ( Rlly, 2010) Tgk α1- rhru rkrk mu ( k 4 u 5) mmlk rwy klurg ku Nl rum α1-r <15 20% r f α1-r (ATS- E RS, 2004) orml mruk r 2 2 M 2 21 T rmolog Muru Brol ulc Hlh (2010), m lh kv mghru r mku kr ugku lm kr gr,, cruu U uk f r, CDC mmlk gk j- j Df gk muru CDC lh g rku: 1 N vr mokr ( k rh m) w k rh m u m lh k r 100 g jg huy Uvr Sumr Ur

13 17 2 F ormr mokr ( k ) w lh m ky 100 g jg huy, mgk hw krg k m 3 N omokr ( uk ) w krg k m, rmuk k k k rh m 4 C urr mokr ( ) w lh m 100 g lm huy 2010) mh m hr u Df l k f k olh rg guk, lh: lm CDC r hr (CDC, mu 1 rg rg krr guk <1 ugku rhr, <15 g rhr, <10 g rhr 1-39 g rmggu 2 rm lh lu cr hy mu umum lm Cr rr, uk r, klu mlm rg hr S ocl oul k (Sch, 2010) mcm ol m mokr, rm jug umum m for D rvo (CDC) mlork hw hu 2011 kr 43,8 ju w Amrk Srk lh I mruk 19% r ol org w (21,6% r r, 16,5% r w) (CDC, 2010) 2 22 K ug Z lm Rokok A g hl mkr r mgug lh r 4000 z km rf okk, krogk ly rf rokf kf k omo rgug h, r, rouk r mku rg lm u komo yu g rkl (Hr kk, 2012) Komo km j mku, (r mh), ol m vu (Syhrj, 2007) Komo g ky, 2 flr u mgug CO, CO2 O, hrog mok, rog, yw hrokro Komo rkl r l ko, zor, f ol, k mum Uvr Sumr Ur

14 8 1 yk CO mmrk k hy CO lm Kr k y mgurg lh ry uuh, folog lm fug gggu o jrg rh okg ul uru rj hgg H g k - rhhgg vko mgkk jug CO uuh lm jrg 2007) (Syhrj, rh gguml mrmuh m ko l komo lh r T r r J uk lm Tr rkl komo kumul mruk wr ruh myk kcokl rwr y 2007) Koz, (G kcokl kug mj jr kuku r ug K 1 < r rkr - gr gg mg ) (Syhrj, rfkrogk Tr rkmg gr mku m muk lm yw lh Nko mmlk hgg lklo, yw klomok lm rmuk Nko k Koz, (G krgug myk crug 12 mghlk gr 007)Rokok 2 - r ko Aor ko mg 29 ok mc ko olu uh c, rlgug hl 10 lmwku - mgkv Nko k 6 1 lkolkok ror m rf m mmgruh Nko om l mmcu kuuh rh, k jug, frkuyu mgkk hgg Nko rfr vokork mguk jug, okg orogrj m rh muluh g romo h y ru h, Nkomolm krovkulr yk huugk ) (Syhrj, gjl ru h CO, ko, N - mruk ruk lm l h muluh ol D rh gguml muly mmrmuh rh, uk Dgk lmk rofl mmgruh mgu, rh rglr LDL, kolrol ol, kolrol kr, r HDL lh gkkolrol gg, h l 2007) (Syhrj, h Uvr Sumr Ur

15 19 T l 21 Kug A Rokok Trlh F rkl E fk F G E fk T r M ugk, krogk C O Gggu k okg H N ko rgg u k rm Ir, ro- flm, N O o lookk Hrokro Ir, ro- flm, M ugk, krogk A lh romk lookk hol I r, mugk, krogk Am Ir, ro- flm, h ro lookk C rol I r, mugk, krogk A krol Ir, ro- flm, lookk β- hylm M ugk, krogk A mo Ir, ro- flm, lookk K kol M ugk, krogk N rom M ugk, krogk B zo()r M ugk, krogk H rz M ugk, krogk I ol M mrc umor V yl Klor M ugk, krogk S umr: Bhr, D rj Br M lh Scr Irol, mgguk l rkl jumlh r- r g lm hu 1 rj rg ( 0-200), Ik Brkm h muk Ik hr rj Brkm, klk r lm yu Tgk rj m rrk Ik Brkm lh: 2 rj g ( ), 3 rj r (>600) (DI, 2003) m uu m 2 24 M km M Myk mgug lk Broy (2006) lm Lo- Lor (2009) r ok kor mguk gg myk Z flm ok ru hw rkf lur Su mujukk hw o rokl ml r lur u, mmlk ruh kro kr flm, m gky jumlh l flm rg g ru, rmolg mruk hl r cr ru rky(lo- L or, 2009) Muru Hougho (2012) lm Vjy (2013), j kro myk kumul r mkrofg rkv, rofl Lmfo T Uvr Sumr Ur

16 0 2 rofl Mkrofg lvolu rug wh ur lur CD8+ lh rofl rouk rlh El ru ro um umr mfm myk r ro mghlk yk rkv 2007 Ly, umr: S Jrg ruh 22 mr G lur l mgkv jug M rjy mmcu huug hw myk Su 2013) (Vjy, rmolg rwy lur oruk krh rofl mkrofg flm gk r (S l mujukk lur oruk Tgk 2001), rj r 0 2 rofl Mkrofg lvolu rug wh ur lur CD8+ lh rofl rouk rlh El ru ro um umr r myk mfm mghlk yk ro rkv 2007 Ly, umr: S 22 ruh Jrg mr G lur l mgkv jug M rjy mmcu huug hw myk Su 2013) (Vjy, rmolg rwy lur oruk krh rofl mkrofg flm gk r (S l mujukk lur oruk Tgk 2001), rj r 0 2 rofl Mkrofg lvolu rug wh ur lur CD8+ lh rofl rouk rlh El ru ro um umr r myk mfm mghlk yk ro rkv 2007 Ly, umr: S 22 ruh Jrg mr G lur l mgkv jug M rjy mmcu huug hw myk Su 2013) (Vjy, rmolg rwy lur oruk krh rofl mkrofg flm gk r (S l mujukk lur oruk Tgk 2001), rj r Uvr Sumr Ur

17 21 l M myk mkrofg rouk MM- 12 mj frol gkruk mghlk rm rh m, r hgg jrg mmlh g Bg l rf kmokk moo mgkk ru I flm mmu ov ro fck rkhr loo kruk rlju r rkm ru ( J o Mclf, 2006) Scr umum, flm ruh rukur lur mgk krh yk rlgug wluu lh m mcu flm rlgug wluu myk rjy ro flm (Wllm lh rh l, 2005) Su rru myk hw r komo uomu, rkoru lm flm lur ur hk lh rh m Auoo mugk cr lgug mlw g r mku u mlw uog og mruk hl r flm kruk ru okf kr m ( Lo- L or, 2009) 2 3 D rj Br 2 31 K rr GOLD Krr GOLD ( G lol Iv for Chroc Orucv Lug D) lh uu krr k cr rol mruk kolor r Nol lm muk Krr rrk Iu of H lh ( NIH) W orl Hlh Orgzo (WHO) rj krh GOLD rj m gklfkk, oruk mrk N l Drj m krr krh GOLD romr (GOLD, 2010) lr mgklfkk ur jug l (oruk) rgu rrk r l Sl romr guk lm u krr GOLD lh: mgo r hl 1 FVC ( F orc Vl Ccy) u K Vl k lh ol volum u r klurk cr k lm kl r Uvr Sumr Ur

18 22 2 FEV1 ( F orc Exrory Volum O Sco) u Volum Ekr k k 1 lh volum ur klurk lm k rm kr k 3 FEV1 / FVC lh ro FEV1 rh FVC yk lm frk ( GOLD, 2013) Krr romr rluk lm krr GOLD go rj krh 2010) S umr: T l lh FEV1 / FVC lh mr rokolor(gold, 22 Krr GOLD Drj Krh D rj K rkrk I : Rg FEV1 / FVC < 0,70 FEV1 80% rk I I: Sg FEV1 / FVC < 0,70 50% FEV1 80% rk I II: Br FEV1 / FVC < 0,70 30% FEV1 50% rk I V: Sg Br FEV1 / FVC < 0,70 FEV1 < 30% rk u FEV1 < 50% rk mh G gl f krok GOLD, 2013 M l COD u rg, h mugk lum myr hw fug ruy k orml M or COD u g, gjl y rkmg h, g mmk mlkuk kv S vr COD u r, mk f mk uruk h rg mm kv hr Ekr y mul rlh h V ry vr COD u g r, h kul hu uh g 2010) rgggu kr mgcm jw (GOLD, Uvr Sumr Ur