• Neurona merupakan satu-satunya jurnal yang memuat perkembangan penelitian dan kasus terbaru bidang neurosains di Indonesia. Jurnal ini diterbitkan setiap 3 bulan sekali oleh Perhimpunan Dokter Spesialis Saraf di Indonesia.

  • Sekretariat:
    Departemen Neurologi FKUI/
    RSUPN Dr. Cipto Mangunkusumo

    Jl. Salemba Raya No. 6 Jakarta 10430, Indonesia
    Telp. +62 21 31903219    Fax. +62 21 2305856
    Phone: 081380651980
    Email: neurona.perdossi@gmail.com

  • Pilih Edisi
    PETUNJUK PENULIS PENGAJUAN ARTIKEL SURAT KOMITMEN SURAT TIDAK PLAGIAT

    Silahkan unduh kelengkapan pengiriman artikel tersebut dan kirimkan kembali ke email redaksi setelah diisi.

Vol 27 No. 3 April 2010


GANGGUAN OTONOM PADA PEKERJA TERPAJAN TIMBAL KRONIK BERDASARKAN PEMERIKSAAN SYMPATHETIC SKIN RESPONSE DAN FAKTOR FAKTOR YANG MEMPENGARUHI
Ekawati Dani Yulianti*, Fitri Octaviana*, Manfaluthy Hakim*, Joedo Prihartono**

ABSTRACT

Introduction: Lead has toxic property to the nervous system. Inorganic lead could damage peripheral nerve system causing neuropathy. Autonomic neuropathy in lead exposed workers is often sub clinical. However, sympathetic skin response (SSR) abnormality was found in asymptomatic chronically exposed to lead workers.

Method: This is a cross sectional study to find out the SSR characteristics in lead exposed workers and their influencing factors. Subjects who met the eligibility criteria where examined for blood lead level and SSR. Subjects were then analyzed according to age, education, working time, working risk, use of self protection device, milk consumption habit, working period, and lead blood level.

Result: There were 61 subjects participated in this study, aged 20 – 50 years old. All subjects were male. Thirty five subjects were classified as high risk and 26 as moderate risk. Average age was 42.3 ± 6.8 years old. Subjects have been working for an average of 20.3 ± 6.8 years. Highest blood lead levels, 50.93 µg//dl and 26.58 µg/dl, were found in two workers who worked in storage battery service. The average value of the remaining subjects’ blood lead level was 13.9 µg/dl, still under 20 µg/dl which is the safety level according to WHO. Autonomic disorder was experienced by 12 workers (19.7%) with either high or moderate risk.
SSR abnormality was significantly associated with the presence of autonomic disorder (P = 0.000; OR = 83.70; 95%CI = 14.59 – 480.0). Age, education, working time, working risk, use of self protection device, milk consumption habit, and working period were statistically not associated with SSR abnormality. Two highest odds ratio were no milk consumption habit (3.75) and working period ≥ 21 years (2.29) although statistically not significant
From ROC analysis we found that on blood lead level 12.6 μg/dl, the sensitivity to find SSR abnormality was 53.6% and the specificity was 36.4%. Twenty three subjects (37.7%) have abnormal SSR.

Conclusion: SSR was more sensitive in detecting autonomic disorder in chronically exposed to lead workers. SSR abnormality was found in lower blood lead level than the safe standard from WHO. Although statistically not significant, milk consumption habit of two glasses a day tends to have protective property while working period ≥ 21 years tends to associate with SSR abnormality. I tended to like

Keywords: Autonomic neuropathy, blood lead level,lead, sympathetic skin response (SSR)

ABSTRAK

Pendahuluan: Timbal merupakan salah satu zat yang bersifat toksik terhadap sistem saraf. Timbal inorganik dapat merusak sistem saraf perifer menyebabkan neuropati. Neuropati otonom yang terjadi pada pekerja terpajan timbal sering bersifat subklinis. Meskipun demikian pada pekerja yang terpajan timbal kronik asimptomatik ditemukan adanya kelainan Skin Sympathetic Response (SSR).

Metode: Penelitian ini merupakan studi potong lintang untuk mengetahui gambaran pemeriksaan SSR pada pekerja terpajan timbal serta faktor-faktor yang mempengaruhinya. Pada subjek yang memenuhi kriteria penelitian dilakukan pemeriksaan kadar timbal darah dan pemeriksaan SSR. Subjek lalu dianalisis menurut usia, pendidikan, jam kerja, risiko kerja, penggunaan alat pelindung diri, kebiasaan minum susu, lama kerja, dan kadar timbal darah.

Hasil: Subjek penelitian sebanyak 61 orang yang berusia 20 – 50 tahun. Semua subjek berjenis kelamin laki-laki. Tiga puluh lima subjek digolongkan dalam risiko tinggi dan 26 subjek risiko sedang. Rata-rata umur subjek 42,3 ± 6,8 tahun. Subjek penelitian telah bekerja rata-rata 20,3 ± 6,8 tahun. Kadar timbal serum yang tinggi terdapat pada dua orang pekerja di bagian accu sebesar 50,93 µg//dl dan 26,58 µg /dl. Sisanya rata-rata 13,9 µg/dl, masih di bawah 20 µg/dl yang merupakan batas aman menurut WHO. Keluhan gangguan otonom dirasakan oleh 12 orang pekerja (19,7%) dengan risiko tinggi dan sedang.
Abnormalitas SSR secara bermakna berhubungan dengan adanya gangguan otonom (P = 0.000; OR = 83,70; 95%CI = 14,59 – 480,0). Usia, pendidikan, risiko tempat kerja, lama kerja, kebiasaan minum susu, dan masa kerja secara statistik tidak berhubungan dengan abnormalitas SSR. Dua odds ratioter tinggi adalah tidak memiliki kebiasaam mengkonsumsi susu dan masa kerja ≥ 21 tahun meski secara statistik tidak bermakna.
Dari analisis ROC ditemukan bahwa pada kadar timbal serum 12,6 μg/dl, sensitifitas ditemukannya abnormalitas SSR sebesar 53,6% dan spesifisitasnya 36,4%. Dua puluh tiga subjek (37,7%) memiliki SSR abnormal.

Kesimpulan: SSR lebih sensitif mendeteksi gangguan otonom pada pekerja yang terpajan timbal kronik. Abnormalitas SSR sudah ditemukan pada kadar timbal serum yang lebih rendah daripada standar aman WHO. Walaupun tidak bermakna secara statistik, kebiasaan minum susu dua gelas/ hari cenderung bersifat protektif sedangkan masa kerja ≥ 21 tahun cenderung berhubungan dengan abnormalitas SSR.

Kata kunci: Kadar timbal darah, neuropati otonom, sympathetic skin response (SSR), timbal

----------------------------------------------------------------------------------------------
*Departemen Neurologi FK Universitas Indonesia/RSUPN Cipto Mangunkusumo, Jakarta, **Departemen Ilmu Kedokteran Komunitas FK Universitas Indonesia/RSUPN Cipto Mangunkusumo, Jakarta


Download Article