trauma (text book read)

8/20/2019 TRAUMA (Text Book Read)

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BAB 52

TRAUMA DAN PERAWATN KLINIS PADA KEKEBALAN

TUBUH DAN IMUNODEFISENSI

Disusun oleh:

Elizabeth H. Sinz

Dea!t"ent #$ Ane%the%i#l#&' an( Ne)!#%)!&e!'* Penn State +#lle&e #$ Me(i,ine* Penn State

Uni-e!%it' H#%ital*

He!%he'* Penn%'l-ania* U.S.A.

Willia" +. Wil%#n

Dea!t"ent #$ Ane%the%i#l#&' an( +!iti,al +a!e* U+ San Die&# Me(i,al +ente!*

San Die&#* +ali$#!nia* U.S.A.

i%hal Ban%alDi-i%i#n #$ T!a)"a* B)!n%* an( +!iti,al +a!e* Dea!t"ent #$ S)!&e!'* U+ San Die&# Me(i,al

+ente!* San Die&#* +ali$#!nia* U.S.A.

PENDAHULUAN

Be!(a%a!/an %i$atn'a* in$e/%i a(a l)/a t!a)"a (aat (iha"bat #leh ba&ian0 e/%te!nal

/)lit (an en(#theli)" )%)%* a!)1a!) (an %'%te" %al)!an /e"ih. Bah/an %ee!ti a(a ,e(e!a

$!a/t)! t)lan& te!t)t) %ee!ti a(a bebe!aa t)lan& ata) a(a ,e(e!a /eala* bebe!aa te!ai

%)!#ti$ (an !e%)%ita%i (aat (ibe!i/an te!lebih (ah)l) (ala" enan&anann'a %ee!ti

e"a/aian /atete! -ena %ent!al* int)ba%i en(#t!a/eal* (an )nt)/ e!bai/an (ila/)/an tin(a/an

be(ah. Di%ebab/an be!(a%a!/an en&ala"an a!a (#/te! baha #ten%i baha'a a/an ti"b)l

aabila ti(a/ (ila/)/an inte!-en%i 'an& in-a%i-e %ehin&&a (aat "en&ha%il/an ha%il bai/.

Pa!a eneliti %ee!tin'a ha!)% ban'a/ "e"baha% tentan& %'%te" /e/ebalan t)b)h*

/a!ena be!(a%a!/an en&ala"an baha e!)bahan i")n a(a %e#!an& in(i-i() (aat (ii,)#leh a(an'a l)/a t!a)"a /a!ena /ea(aan ini (aat "enin&/at/an %'%te" /e/ebalan t)b)h (an

bebe!aa $a/t#! lain 3)&a (aat "e"en&a!)hi e!)bahan te!%eb)t. Penelitian 'an& telah la"a

"en3a(i (aat (i&)na/an /e"bali %ee!ti "e/ani%"e !e&)la%i /#"le/%ita% 'an&

be!h)b)n&an (en&an %'%te" /e/ebalan* (an "e"aha"i be!ba&ai /#n(i%i -a!ia%i i")n#l#&i

'an& be!e%#n te!ha(a anti&en. Bebe!aa ele"en en&#batan lainn'a (aat (ibe!i/an

te!"a%)/ antibi#ti/* n)t!i%i (an /e/ebalan 'an& "e"en&a!)hi -entila%i.

Bab ini "e"baha% %i%te" /e/ebalan t)b)h "an)%ia (an e$e/ t!a)"a* l)/a ba/a!* (an

en'a/it 'an& /!iti%. Bab ini 3)&a "e"baha% bebe!aa e$e/ %i%te"i/ 'an& )")" a(a



bebe!aa en'a/it %'%te" /e/ebalan t)b)h* te!"a%)/ "ene!an&/an tetan& a)t#i")n (an

enelitian 'an& %e!in& (ibaha% #leh a!a eneliti lainn'a. A)t#i")nita% be!e!an entin&

(ala" &an&&)an i(i#ati/ %ee!ti en'a/it in$e/%i &in3al* "'a%thenia &!a-i%* a!th!iti%

!he)"at#i(* (an en'a/it lainn'a 'an& %ebel)"nn'a be!h)b)n&an (en&an 4en'a/it -a%/)la!

/#la&en. Selain it)* "e"baha% ba&ian /h)%)% t!a)"a (an e!aat /lini% a(a human

immunodeficiency virus 6HI7. Ke")(ian "e"baha% %)!-ei tentan& a&en in$e/%i 'an&

bia%an'a "en&enai a%ien 'an& immunocompromised lal) (ii/)ti review %in&/at tentan&

e!ti"ban&an %e#!an& a%ien 'an& "en&ala"i /ea(aan i"")n#%)!e%i )nt)/ "ela/)/an

t!an%lanta%i #!&an a(at. Ba&ian “Eye to the Future” "e"be!i/an &a"ba!an %e/ila% tentan&

/elan3)tan enelitian (i bi(an& "#()la%i /e/ebalan t)b)h a(a t!a)"a (an e!aatan

/lini%n'a.

PEMBAHASAN SISTEM KEKEBALAN TUBUH

ANATOMI BARRIER

Pe!tahanan8ba!!ie! e!ta"a a(a t)b)h "an)%ia te!ha(a a(an'a in$e/%i %e,a!a

n#!"al (ilin()n&i #leh /)lit* %al)!an naa%* (an )%)%. Ba!!ie! ini (aat te!&an&&) #leh a(an'a

,e(e!a t!a)"ati/ ata) te!ai 'an& in-a%i-e 'an& (i(aat #leh in(i-i() 'an& "en&ala"i

en'a/it 'an& /!iti%. Ka!ena a(an'a ha"batan $i%i/ a(a eitel /e!atin* ba/te!i 3a!an& (aat

be!tahan hi() (ala" 3)"lah be%a! (i e!")/aan /)lit. Selain it)* e$e/ lan&%)n& antiba/te!i

%ee!ti a%a" la/tat (an le"a/ (ala" /elen3a! /e!in&at (an %aba%ea (aat "en)!)n/an H (an

"enin&/at/an e!")/aan e/%te!nal a(a /)lit %ehin&&a ba/te!i ti(a/ (aat be!tahan hi()

(i%ana. Pen&e,)alian te!ha(a Staphylococcus aureus* 'an& %e!in& "en'e!an& (i $#li/el

!a"b)t (an /elen3a! /e!in&at.

Pe!lin()n&an 'an& be!%i$at antiba/te!i 3)&a (ibe!i/an #leh %ela)t len(i! ")/#%a 'an&

"elai%i e")/aan t)b)h* te!"a%)/ )%)% (an eitel %al)!an 3alan naa%. Fa/t#! /h)%)% )nt)/

e!lin()n&a anti"i/!#ba %ee!ti i"")n#&l#b)lin A 6I&A7 (an /#"le"enn'a 'an& %elal)

"e"bant) )nt)h "e"b)n)h ba/te!i. Fa/t#! ba/te!i%i( 3)&a telah (ite")/an %ee!ti a%a"

la"b)n&* %e!"ine an( zinc a(a ai! "ani* %e/!e%i ,ai!an hi()n&* (an ai! li)!. A%a" la/tat

3)&a (iha%il/an #leh #!&ani%" /#"en%al (ala" -a&ina 'an& be!&)na )nt)/ "e"bant)

"elin()n&i (ae!ah te!%eb)t te!ha(a ba/te!i pathogen. Mi/!#ba ath#&en 'an& be!a(a a(a

%al)!an naa% %e!in& te!3eba/ a(a len(i! (an (iha)% #leh %e,a!a "e/ani% #leh %ilia* bat)/*

(an be!%in. Fa/t#!1$a/t#! "e/ani% lainn'a te!"a%)/ ai! "ata* %ali-a* (an )!in. Sel Lan&e!han%

'an& te!(aat (i /)lit (an %el (en(!iti/ 'an& be!a(a (i inte!%titi)" (a!i be!ba&ai 3a!in&an*



3)&a be!e!an a/ti$ %e,a!a te!)%1"ene!)% )nt)/ "en'e!an& ba/te!i pathogen 'an& be!a(a (i

(ala" t)b)h.

Setelah /)"an pathogen (ihalan&i #leh ba!!ie e!ta"a #leh t)b)h 'ait) /)lit*

e!na$a%an* &a%t!#inte%tinal 69I7* (an ata) eitel &enit#)!ina!'* /e")(ian /)"an pathogen

ha!)% "eleati %i%te" /e/ebalan t)b)h.

P!#%e% /e/ebalan t)b)h bai/ 'an& (i(aat "a))n baaan "en&a,) a(a %'%te"

'an& telah be!la/) %ebel)"n'a* (i"ana /e/ebalan t)b)h n#n1%e%i$i/ "elibat/an e!e/!)tan

(an elea%an "a/!#$a&* ne)t!#$il* %el Natural Killer 6NK7* %it#/in (an bebe!aa !e%et#!

%el)le!* (an system complement . Ke/ebalan (i(aat "elibat/an anti&en %e%i$i/ (an

"elibat/an /e()a %e%i$i%ita% (an 4e$e/ "e"#!' (a!i li"$#%it1T (an li"$#%it1B. Si%te"

/e/ebalan t)b)h 'an& (i(aat (iba&i "en3a(i ()a 'ait) /e/ebalan t)b)h h)"#!al (an %el)le!*

/e()a /e/ebalan t)b)h ini be!/#")ni/a%i "elal)i en&a!)h (a!i %it#/in. System complement

3)&a be!e!an a/ti$* bai/ (ala" /e/ebalan h)"#!al (an %el)la!* (an be!$)n&%i %eba&ai

en&h)b)n& anta!a /e/ebalan (i(aat (en&an /e/ebalan baaan.

Table 1 Leukoc!es In"ol"e# in !he I$$une Ss!e$

%ell T&e 'unc!ion Su()ace $a(ke( S&ecial !(ai!s

T*hel&e( +Th,

1 Sti")late B1,ell%0 !#-i(e%%e,i$i, an( n#n%e,i$i,

,'t#/ine %i&nal% $#! a,ti-ati#n

an( (i$$e!entiati#n

1 A,ti-ate "a,!#ha&e%0

,'t#/ine% !#-i(e "e%%a&e $#!

a,ti-ati#n

+D:;* +D<;*+D=1

+D:;* +D<;*+D=1

1 MH+ ,la%% II "a!/e!%!e%t!i,t a,ti-ati#n Th2

a,ti-ate% B1,ell%* "a/e%

IL1<

1 MH+ ,la%% II "a!/e!%

!e%t!i,t

a,ti-ati#n Th> a,ti-ate%

"a,!#ha&e%* "a/e%

inte!$e!#n1?

T*c!o!o-ic +Tc, L'%e anti&en e@!e%%in& ,ell%0 %),h a%th#%e in$e,te( b' -i!)%* #! all#&!a$t%

+D:;* +D<1* +D=; MH+ ,la%% I "a!/e!%!e%t!i,t a,ti-it'

Tsu&&(esso( +Ts, D#n!e&)late% ,ell)la! an( h)"#!al

I"")nit'

+an be +D:; #! +D:1

U%)all' +D<1* +D=;

T(e.ula!o(+TRE/, S)!e%%e% T1,ell1"e(iate(

In$la""ati#n

+D<;* +D25; Di"ini%he%

a)t#i"")nit'

NK S#ntane#)% l'%i% #$ t)"#! ,ell%*

Ab1(een(ent ,ell)la! ,'t#t#@i,it'

F, !e,et#! $#! I&9 MH+ ,la%% I "a!/e!%

!e%t!i,t a,ti-it'



NK T*cells A"li$' b#th ,ell1"e(iate( an(

h)"#!al i"")nit'

CD4 + E@!e%% a !e%t!i,te(

%)b%et #$ %)!$a,e

"a!/e!% 67

B cells Ab P!#(),ti#n* an( !e%ent% anti&en

t#

T1,ell%

F, an( +:(

!e,et#!% MH+

,la%% II

Di$$e!entiate int#

la%"a ,ell% 6hi,h

!#(),e Ab7

Mac(o&ha.es

+$onoc!es,

Pha&#,'t#%i%* %e,!eti#n #$ ,'t#/ine%

t#

a,ti-ate T1,ell% 6e.&.* IL1>7*

ne)t!#hil%

Ma,!#ha&e %)!$a,e

anti&en%* an(

4a!"e( ith Ab

bin(in& t# F,

!e,et#!%

E@!e%% %)!$a,e

!e,et#!% $#! +:a* /ill

in&e%te( ba,te!ia b'

#@i(ati-e b)!%t%

PMN +neu!(o&hils, Pha&#,'t#%i% /illin& +an be4a!"e( ith

Ab

P!#te,ti-e in a!a%iti,

in$e,ti#n%* b)t a(-e!%e

e$$e,t% 6e.&.* &!an)l#"a7

,an #,,)!

Abb!e-iati#n%0 Ab* antib#(' +:a* a,ti-ate( thi!( ,#"#nent #$ ,#"le"ent IL* inte!le)/in MH+*

"a3#! hi%t#,#"atibilit' ,#"le@ PMN* #l'"#!h#n),lea!

NK* nat)!al /ille!.

I$uni!as Selula(

Seb)ah &a"ba!an 'an& 3ela% te!(aat %el (a!ah )tih 6WB+7* 'an& te!libat (ala" %i%te"

/e/ebalan t)b)h 6Tabel >7. Ke/ebalan t)b)h %el)la! (i"e(ia%i #leh t)!)nan li"$#%it1T a(a

ti")%. Pa(a li"$#%it %e/ita! C5 te"at be!e(a!n'a %el1T. Setia %el1T %e,a!a &eneti/

(i!#&!a" )nt)/ "en&enali (an "en&i/at %el %e%i$i/ 'an& be!i/atan (en&an anti&en (en&an

"e"bent)/ !e%et#! anti&en1%e%i$i/ %el1T 6T+R7. Setia anti&en1%e%i$i/ T+R te!/ait

(en&an %e/el#"#/ #lieti(a n#n1-a!iable 'an& (i%eb)t (en&an "#le/)l ,#"le/% +D:.

P!#tein +D: ini te!libat (ala" t!an%()/%i %in'al /e %el1T %etelah anti&en1%e%i$i/ "en&i/at

anti&en1T+R. Selain !#tein +D:* %el1T 3)&a (aat "en(e%/!i%i/an be!ba&ai !#tein 'an&

te!/ait (en&an $)n&%i non-polymorphic* (i"ana !#tein 'an& te!entin& a(alah +D< (an

+D=.

+D< (an +D= "e!)a/an ()a %et 'an& %alin& e/%/l)%i$ )nt)/ %el1T (an ,#1!e%et#!

(a!i a/ti-a%i %el1T.

Sela"a e/%!e%i anti&en* "#le/)l +D< "en&i/at ba&ian )ta"a /#"le/%

hi%t#/#"atibilita% n#n#li"#!$i/ 6MH+7 "#le/)l /ela% II a(a anti&en1%el presenting .

Sebali/n'a* "#le/)l +D= "en&i/at ba&ian n#n#li"#!$i/ MH+ "#le/)l /ela% I. Pa(a %el1T

+D<; "en%e/!e%i/an %it#/in 'an& be!$)n&%i )nt)/ "e"en&a!)hi %etia 3eni% %el (ala"



%'%te" /e/ebalan t)b)h te!"a%)/ %el1T* %el1B* "a/!#$a&* (an %el NK. Sel1T +D<; ini

be!e!an entin& (ala" "e"b)/ti/an h#%t a(a in$e/%i HI (an %e,a!a %ele/ti$ (aat

"e"b)n)h %el1T +D<; 6(i3ela%/an /e")(ian7. Sel1T +D=; 3)&a "en%e/!e%i/an %it#/in

tetai te!)ta"a %el %it#t#/%i/.

Se/ita! >5 li"$#%it 'an& be!e(a! (i e!i$e! be!a%al (a!i %)"%)" t)lan& "e!)a/an

li"$#%it B. Pa(a a%ien (ea%a li"$#%it1B (aat (ite")/an (i %)"%)" t)lan&* li"$#%it*

li"a* t#n%il* (an #!&an e@t!ali"$ati/ 6te!"a%)/ Pe'e!% at,he% (i ile)"7. Setelah a(an'a

!an&%an&an anti&en* %el1B be!)bah "en3a(i %el la%"a (an "en%e/!e%i i"")n#&l#b)lin* 'an&

"e!)a/an "e(iat#! )ta"a i")nita% h)"#!al.

Pa(a %e")a e!")/aan %el1B (aat (ite")/an i"")n#&l#b)lin1M 6I&M7* 'an& te!(i!i

(a!i /#"#nen !e%et#! %el1B 'an& "en&i/at anti&en. See!ti %el1T* %el1B 3)&a "e"il/i

/e/h)%)%an anti&en* /a!ena %eba&ian %t!)/t)!n'a te!(i!i (a!i "#le/) I&M. Selain it) "#le/)l

I&M* %el1B "e"ili/i !#tein t!an%"e"b!an n#n1#li"#!$i/ 'an& "i!i (en&an !#tein +D:

T+R. Sel1B "e"il/i !e%et#! n#n1#li"#!$i/ lain 'an& (ie!l)/an "en&a/ti$/an $)n&%i

!e%et#! /#"le"en* !e%et#! F, (an +D<. Mena!i/n'a* !e%et#! /#"le"en %el1B 6+D2>7

be!i/atan (en&an -i!)% E%tein1Ba!! 6EB7* "a/a (a!i it) (aat "en3ela%/an "en&aa EB

%e!in& "en&in$e/%i %el1B. Selain it)* "#le/)l +D< "e!)a/an an&&#ta (a!i !e%et#! tumor

necrosis factor-a 6TNF1a7 (an be!inte!a/%i anta!a %el1T hele! +D<; (an %el1B. Sel1T hele!

'an& a/ti$ "en&e/%!e%i/an li&an +D< (i"ana en&i/at +D< (i(e%/!i%i/an #leh %el1B*

'an& (i&)na/an )nt)/ e"atan&an la%"a%it 'an& "en&ha%il/an I&9*I&E*(an I&A. Pa%ien

(en&an ")ta%i a(a li&an +D< ti(a/ "en&ha%il/an i"")n#&l#b)lin 'an& ,)/) (an

"e"ili/i i"")n#(e$i%ien%i 'an& (i%eb)t X-lined hyper-!g" syndrome.

Ma/!#$a& a(alah ba&ian (a!i %i%te" $a&#%it "#n#n)/lea! 'an& te!libat (ala" /e()a

e!a(an&an (an i")nita%. Be!i/)t a(alah %el e!ta"a /ali be!"i&!a%i a(a (ae!ah ,e(e!a

t!a)"a 'ait) %el ne)t!#$il #li"#n#n)/lea! 6PMN7 (en&an 3)"lah alin& ban'a/ a(a 2< 3a"

e!ta"a* (ii/)ti #leh "a/!#$a&* 'an& 3)"lah "en3a(i ban'a/ a(a a/t) G2 3a" be!i/)tn'a.

Ma/!#$a& "e"ili/i e!an entin& (ala" !e%#n /e/ebalan t)b)h* a(a aaln'a* "a/!#$a&

be!$)n&%i %eba&ai %el en'a3i anti&en /e %el T. Selain it) (en&an a(an'a %it#/in (a!i %el T

+D< (an "a/!#$a& a/an (aat "e"b)n)h %el t)"#! (an bebe!aa %el t)"#! 3ina/ lainn'a.

Ma/!#$a& be!e!an 3)&a (ala" i")nita% h)"#!al %ee!ti ha&#%it#%i% ba/te!i (an "i/!#ba

lainn'a 'an& telah #%#nize( 6(ilai%i7 #leh I&9 ata) +:b 6$a/t#! (ala" "elen&/ai7. Sel

(en(!iti/ be!e!an %eba&ai anti&en !e%entin& (an (ina"a/an (e"i/ian /a!ena e/%ten%i

%it#la%"a* "e"bentan& (a!i %el )ta"a (i t)b)h. Sel Lan&e!han% a(alah %el1%el (en(!iti/

te!leta/ (i ei(e!"i% 'an& ")n&/in ti(a/ be!$)n&%i (ala" /ea(aan l)/a ba/a! 'an& a!ah.



Sel (en(!iti/ (i(i%t!ib)%i/an %e,a!a l)a% (ala" 3a!in&an li"$#i( (an (ala"

3a!in&an !)an& inte!%i%ial n#n1li"$#i( %ee!ti a!)1a!) (an 3ant)n&. Dala" li"a (an

l'"hn#(e%* %el (en(!iti/ (i%eb)t %eba&ai %el (en(!iti/ $#li/)le! (an I&9 "en&e/%!e%i/an

!e%et#! F, )nt)/ "ela'ani anti&en e!an&/a #%#ni%a%i #leh antib#(i.

Sel NK te!(i!i (a!i %e/ita! > li"$#%it e!i$e!. Sel1%el NK lebih be%a! (a!ia(a

/eban'a/an li"$#%it* "e!e/a "e"ili/i !e%et#! F, I&9 'an& "en&i/at (an "e"b)n)h ,ell%.

Ba&ai"ana)n* #%#ni%a%i* #leh %el NK, telah "en,a!i (an "e"b)n)h %el a%in& (en&an

bebe!aa ,a!a. Sel1%el NK "e"ili/i "e/ani%"e !e%et#! 'an& "en&enali "#le/)l MH+ /ela%

I 6'an& a(a e!")/aan %e")a %el "a"alia 'an& n#!"al7 (an ti(a/ %e!an&an ini. Na")n* %el

ti(a/ "e"ili/i MH+ /ela% I "#le/)l 6"i%aln'a* ba/te!i* t)"#!7 (i%e!an& #leh e!$#!ante%

"e"b!an %el (en&an )/)lan "#le/)l 'an& (i%eb)t e!$#!in* (an "en')nti//an !#tein %el

(e%t!)/ti$ 'an& (i%eb)t %el NK &!anz'"e%. A(alah ba&ian (a!i %'%te" /e/ebalan baaan.

Selain it)* %el NK (aat "en'e!an& bebe!aa %el h#%t (en&an "#le/)l MH+ /ela% I

te!/ait (en&an "#le/)l e!")/aan lain 'an& "en)n3)//an /ea(a %el NK baha %el inan&

telah te!in$e/%i #leh -i!)%. M#le/)l MH+ /ela% II te!bata% a(a li"$#%it* "a/!#$a&* (an %el

(en(!iti/ 6anti&en1!e%entin&7.

E!it!#%it (an t!#"b#%it 3)&a "e"ili/i e!an (ala" %i%te" /e/ebalan t)b)h* 'an& ti(a/

%e!in& (ia/)i. Ke()a %el (a!ah "e!ah (an t!#"b#%it "e"ili/i !e%et#! )nt)/ "elen&/ai*

(an t!#"b#%it (i %a"in& it) 3)&a "e"ili/i !e%et#! F, I&9. Den&an (e"i/ian* "e!e/a bi%a

"e"ain/an e!an (ala" e"ebena!ab /#"le/% i")n (an anti&en 'an& telah te!##ni%a%i

#leh /#"le"en.

I$uni!as Hu$o(al

I")nita% h)"#!al a%i$ (ibe!i/an /eti/a antib#(i (ie!#leh (a!i %)"be! e/%te!nal. Hal ini

te!3a(i %e,a!a ala"i %ela"a /eha"ilan "an)%ia #leh t!an%$e! I&9 ib). I&9 ib) %e,a!a be!tahahilan& %ela"a tah)n e!ta"a /ehi()an. Ba'i 'an& (ibe!i ASI 3)&a "en(aat/an I&A ib)

"e"be!i/an e!lin()n&an 'an& l#/al te!)ta"a )nt)/ )%)%. L)a! ba'i* i")nita% h)"#!al a%i$

(aat (ibe!i/an #leh i")n#&l#b)lin "an)%ia (ibe!i/an a!ente!al. Sebali/n'a* i")nita%

h)"#!al a/ti$ te!3a(i /eti/a %i%te" /e/ebalan t)b)h "ene")/an anti&en bai/ /a!ena in$e/%i

ala"i ata) -a/%ina%i. K#n%ent!a%i %e!)" !elati$ (an /a!a/te!i%ti/ /ela% te!i%ah (a!i

i")n#&l#b)lin (i!in&/a% (ala" Tabel 2. Anti&en (aat (i/ate&#!i/an %eba&ai ti")%1

in(een(en 6TI7 tie > ata) tie 2 (an ti")% be!&ant)n& 6TD7 be!(a%a!/an "e/ani%"e(#"inan ata% %el1B a/ti-a%i. TI1tie > anti&en "i/!#ba ata) %a')! "#le/)l 'an& "en&i/at %el1

en



B (an "e!an&%an& !#li$e!a%i (an (i$e!en%ia%i !e%#n antib#(i %e%i$i/ ata) n#n%e%i$i/. TI1

tie 2 anti&en (#"inan "eni"b)l/an anti&en1%e%i$i/ te!ha(a !e%#n antib#(i. Keban'a/an

!#tein (an &li/#!#tein anti&en 'an& (iha(ai #leh %i%te" /e/ebalan t)b)h TD

anti&en. D)a 3eni% inte!a/%i %el)le! 'an& (ie!l)/an )nt)/ !e%#n antib#(i te!ha(a anti&en

TD. T1%el ha!)% "en&enali anti&en 'an& te!/ait (en&an "#le/)l MH+ /ela% II a(a

e!")/aan %el anti&en1!e%entin&. Selan3)tn'a* %el B (an T1hele! be!inte!a/%i %el* (an %el1B

"en&inte!nali%a%i anti&en. Setelah anti&en (i!#%e% (an te!/ait (en&an

M#le/)l MH+ /ela% II* %el T1hele! "a") "en&enali %el 'an& teat )nt)/ "e"be!i/an

%in'al "e!an&%an& n'a.

Keti/a h#%t "e"ili/i !a1e@i%tin& antib#(i 'an& be!e(a! a/ibat -a/%ina%i ata) in$e/%i

%ebel)"n'a* !eli/a%i "i/!#ba (aat (ihenti/an a(a aal in$e/%i. Ini ha%il !e%#n %e/)n(e!

antib#(i (a!i a/ti-a%i "e"#!i %el1B. Sel1%el "e"#!i bia%an'a be!e(a! l)a% (an be!tahan )nt)/

3an&/a a/t) 'an& la"a. Pa(a inte!a/%i (en&an anti&en* antib#(i 6(i(#"ina%i I&9* I&A* (an

I&E7 'an& ,eat (i!#()/%i. Sebali/n'a* !e%#n i")n h)"#!al !i"e! 6I&M "a'#!ita%7

")n&/in te!lal) la"bat )nt)/ "elin()n&i te!ha(a at#&en ban'a/.

Tabel 0 S!(uk!u(al #an Si)a! Biolo.i I$uno.lobulin Manusia

P!#e!t' I&9 I&A I&M I&D I&M

A&&(o-i$a!e $ass

+DA,

>5. >C.

<C.

J.

"e"b

>=.

>=. >J.

Se(u$ concen!(a!ion

+$.$l,

>5 :.5 2. .: .5

Se(u$ hal)*li)e +#as, 2: C 5 21= >15

E-is! as &ol$e( ; ;;

A..lu!ina!in. ;;

%o$&le$en! )i-a!ion ; ;;;

Rea.enic ac!i"i! ;;;



Lsis o) bac!e(ia ; ; ;;;

An!i"i(al ac!i"i! ; ;;; ;

P(esen! o) sec(e!ions ;;;

B*cell (ece&!o( )o(

an!i.en

Placen!al !(ans)e(

; 6"e"#!'7

;

; 6"e"#!'7

; 6!i"a!'7

; 6"e"#!'7

; 6"e"#!'7

Sin&/atan0 I&* i")n#&l#b)lin* ti(a/ (i/etah)i.

Sis!e$ Ko$&le$en

Si%te" /#"le"en te!(i!i (a!i %e/el#"#/ !#tein la%"a* 'an& entin& )nt)/ antib#(i

)nt)/ "en,aai en&han,)!an %el a%in&* ba/te!i* (an %el a#t#%i%. P!#tein "elen&/ai

/)!an&n'a %e%i$i%ita% i")n#l#&i* tetai te!(i!i (a!i %i%te" /a%/a(e 'an& %an&at /#"le/%

'an& te!(i!i (a!i :5 !#tein (i%/!it 6>2 (i anta!an'a te!libat lan&%)n& (ala" 3al)! elen&/a*

%e"enta!a %i%an'a "e"ili/i $)n&%i !e&)la%i7. K#"#nen !#tein /#"le"en (ibe!i n#"#!

(ala" )!)tan ene")an "e!e/a (a!ia(a )!)tan (i "ana "e!e/a (ia/ti$/an. Me%/i)n ti(a/

a(a /e/h)%)%an /e/ebalan a(a a/ti-a%i /#"le"en* ata) e$e/n'a* a(a bebe!aa "et#(e

i")n#l#&i (i"ana %i%te" /#"le"en (aat (ia/ti$/an. Bebe!aa /#"#nen /#"le"en

"enin&/at/an e$e/ anti&en1antib#(i inte!a/%i 6%ee!ti 'an& te!3a(i (en&an #%#ni%a%i7*

%e(an&/an 'an& lain "enin&/at/an !e%#n in$la"a%i (en&an "en%ti")la%i elea%an zat

-a%#a/ti$* (an /e"#ta/%i% "e!an&%an& le)/#%it 6Tabel :7.

Ti&a 3al)! bi#/i"ia (aat "en&a/ti$/an %i%te" /#"le"en 6%e")a be!/)")l (i +:70

6>7 3al)! /la%i/* 627 /#"le"en 3al)! alte!nati$* (an 6:7 3al)! le,tin Mannan "en&i/at 6MBL7 3

6<7. Se")a ti&a 3al)! h#"#l#& "en&ha%il/an -a!ian +:1,#n-e!ta%e. Enzi"* +:1,#n-e!ta%e

ini%iat 3al)! "e"b!an1%e!an&an "en,aai )n,a/n'a (en&an e!a/itan /#"le/% %e!an&an

"e"b!an 6MA+7* 'an& en(!#(),t ,'t#l'ti, (a!i /a%/a(e "elen&/ai te!(i!i (a!i +5b* +C*

+G* +=* +J (an #li"e!. MA+ enta"e! "e"a%)//an /e (ala" "e"b!an %el (an bent)/

%al)!an t!an%"e"b!an 'an& "en'ebab/an li%i% #%"#ti/ (a!i %el ta!&et.



Tabel 2 Ti.a 'un.si )isiolo.is U!a$a Sis!e$ Ko$&le$en

'unc!ionMechanis$ o) ac!ion %o$&le$en! &(o!ein

(es&onsible )o( ac!i"i!

Hos! #e)ense a.ains! in)ec!ion • O%#nizati#n

• +he"#ta@i% an( le)/#,'te

a,ti-ati#n

L'%i% #$ ba,te!ia an( ,ell%

• +#-alentl' b#)n( +: an(

+< $!a&"ent%

• Anah'lat#@in% 6+5a*

+:a* an( +<a7 le)/#,'te

anah'lat#@in !e,et#!%

• MA+ 6+5b+J7

In!e()ace be!3een inna!e an#

a#a&!i"e i$$uni!

• A)&"entati#n #$ antib#('

!e%#n%e

• Enhan,e"ent #$

i"")n#l#&i, "e"#!'

• +:b an( +<b b#)n( t#

i"")ne ,#"le@e% an( t#

anti&en +: !e,et#!% #n

B1,ell% an( anti&en

!e%entin& ,ell%

• +:b an( +<b b#)n( t#

i"")ne ,#"le@e% an( t#

anti&en +: !e,et#!% #n

$#lli,)la! (en(!iti, ,ell%

Dis&osal o) 3as!e • +lea!an,e #$ i"")ne

,#"le@e% $!#" ti%%)e%

+lea!an,e #$ a#t#ti, ,ell%

• +> ,#-alentl' b#)n(

$!a&"ent% #$ +: an( +<

+> ,#-alentl' b#)n(

$!a&"ent% #$ +: an( +<

Abb!e-iati#n0 MA+* "e"b!ane1atta,/ ,#"le@.

S#)!,e0 F!#" Re$. <.

4alu( Klasik

K#"le"en 3al)! /la%i/ (i")lai #leh anti&en1antib#(i /#"le/% 'an& "elibat/an I&M ata)

I&9* bai/ (en&an "en&i/at +> (i ba&ian F, "e!e/a ata) (en&an "en&i/at lan&%)n& (a!i +>

/e e!")/aan at#&en. K#"le/% +> (iha"bat #leh +>1inhibit#!. K#"le/% +> %e/a!an&

"en&i/at (an e!e,ahan +2 (an +< /e +2A (an +<b. +<b (an +2A "en&i/at )nt)/

"e"bent)/ +:1,#n-e!ta%e 6+<b2a /#"le/%7. P!#()/%i +:1,#n-e!ta%e %in'al aal (a!i 3al)!

"e"b!an1%e!an&an 63al)! a/hi! 'an& )")" (a!i %e")a ti&a !)te a/ti-a%i7.



4alu( Al!e(na!i)

al)! alte!nati$ ini lebih !i"iti$ (a!ia(a 3al)! /la%i/* (an ti(a/ "e"e!l)/an /eha(i!an

antib#(i. Sebali/n'a* +: (aat (ihi(!#li%i% lan&%)n& #leh en(#t#/%in* ata) /#nta/ be!i/)t

(en&an /#n%tit)en (in(in& %el ba/te!i* (i/)")l/an I&A* ata) %eba&ai bent)/ )"an bali/

a"li$i/a%i %etelah a/ti-a%i +: #leh %alah %at) (a!i ti&a 3al)! /#"le"en )ta"a. Di 3al)!

alte!nati$* +: (iba&i "en3a(i +:A (an +:b. Bebe!aa +:b te!i/at )nt)/ at#&en (i "ana ia

a/an "en&i/at B $a/t#! /#"le/% ini /e")(ian a/an (ibelah #leh

$a/t#! D /e Ba (an 3al)! alte!nati$ +:1,#n-e!ta%e* Bb. Den&an /ata lain* %etelah hi(!#li%i% +:*

/#"le/% +:b )nt)/ "e"bent)/ +<b2a:b* 'an& "e"#t#n& +5 /e +5a (an +5b. +5a (an

+:A (i/enal )nt)/ "e"i,) (e&!an)la%i %el "a%t (an "elea%/an hi%ta"in anta!a !#()/

!#()/ lainn'a 6lihat #l)"e >* Bab ::7. +5b* be!%a"a (en&an +C* +G* +=* +J (an* bent)/

MA+ 6+5bCG=J7.

4alu( Lec!in

al)! le/tin a(alah h#"#l#& (en&an 3al)! /la%i/* tetai (en&an #%#nin* MBL* b)/an +>.

al)! ini (ia/ti$/an #leh MBL "en&i/at !e%i() "ann#%a a(a (in(in& %el "i/!#ba* 'an&

"en&a/ti$/an !#tea%e %e!in MBL te!/ait* MASP1> (an MASP12* 'an& /e")(ian (aat

"e"ba&i +< (an +2 /e +<b (an +2A* 'an& /e")(ian "en&i/at be!%a"a1%a"a

)nt)/ "e"bent)/ +:1,#n-e!ta%e* %ee!ti (i 3al)! /la%i/.

Melen.ka&i Ke!e(liba!an Kekebalan #ala$ Penaki!

Si%te" elen&/a "e"ain/an e!an (ala" en'a/it i")n#l#&i ban'a/ te!"a%)/ ana$ila/%i%*

a%"a* l))% e!ite"at#%)% %i%te"i/ 6SLE7* (an be!ba&ai bent)/ !a(an& %en(i*

3ant)n& en'a/it a)t#i")n* (an ")ltile %,le!#%i%. Selain it)* /e/)!an&an (a!i /#n%tit)en (i

ba&ian te!"inal (a!i 3al)! /#"le"en !e(i%#%i%i in$e/%i* te!)ta"a "enin&iti%* (an in$e/%i

/a!ena ba/te!i (ien/a%)la%i "e"e!l)/an #%#ni%a%i )nt)/ /e"atian 6"i%aln'a*

Pne)"#,#,,)%* Nei%%e!ia* (an Hae"#hil)% in$l)enzae7.

Pe(a!u(an i$unolo.i #an Tole(ansi

Me/ani%"e e$e/t#! i")n a(alah !#%e% 'an& /)at 'an& (aat "en'ebab/an %el (an

/e!)%a/an 3a!in&an* /a!ena it)* /#nt!#l (e/at a/ti-a%i %i%te" /e/ebalan t)b)h %an&at entin&.

T1%el "en&at)! /e()a "e/ani%"e e$e/t#! h)"#!al (an %el)le!. Pe"ba&ian +D< T hele!



6Th7 %el "en3a(i ()a hi")nan ba&ian $)n&%i#nal* Th> (an Th2* a(alah a!a(i&"a )nt)/

"e"aha"i ba&ai"ana in$la"a%i a)t#i")n 'an& (iat)! #leh %it#/in (an /e"#/in. Sit#/in

inte!le)/in 6IL7 1>2 (an inte!$e!#n1a* 'an& (i%e/!e%i #leh anti&en1!e%entin& %el*

"e"!#"#%i/an !#in$la"a%i (an ,'t#(e%t!),ti-e Th> "elal)i %e/!e%i tan&&aan

inte!$e!#n1(an TNF1a* %e(an&/an IL1< "e"!#"#%i/an !e%#n Th2 (en&an a/ti-a%i %el1B.

Ke"#/in a(alah !#tein ,he"#ta,ti, (i%e/!e%i/an #leh be!ba&ai 3eni% %el* (an "elal)i

inte!a/%i "e!e/a (en&an !e%et#! %e%i$i/* "en&a!ah/an lal) linta% %ele/ti$ le)/#%it %el)!)h

%i%te" li"$#i( (an /e %it)% e!a(an&an. Setelah (ia/ti$/an* %e3)"lah be%a! %el 'an&

"e"!#()/%i %it#/in (i!#()/%i* /a!ena it)* a(alah entin& baha !#%e% "en3a(i (i!i

te!bata% )nt)/ "en&hin(a!i ,e(e!a be!lebihan.

Si%te" /e/ebalan t)b)h e!at (iat)! #leh %eb)ah !#%e% 'an& (i%eb)t t#le!an%i. Pa(a

-e!teb!ata* t#le!an%i te!3a(i a(a be!ba&ai tin&/at. Salah %at) 'an& alin& "en(a%a! a(alah

/eha(i!an (i!i1enan(a a(a "e"b!an %el a%li* "i%aln'a* MH+ /ela% I 'an& "en&i/at

%t!)/t)! (i3ela%/an (i ata%. Sel tana MH+ /ela% I (i!i1!#tein (i%e!an& %eba&ai a%in&.

Me/ani%"e lain a(alah (en&an !e&)la%i ne&ati$ a/ti-a%i1in()/%i /e"atian %el* bent)/

a#t#%i% 'an& a/hi!n'a (aat "e"b)n)h %el1%el. Si%te" elen&/a "e"ain/an e!an

te!i%ah/an (ala" e"be!%ihan %el1%el a#t#%i% (an /#"le/% i")n (a!i la%"a (an

3a!in&an. Bebe!aa %in'al )"an bali/ ne&ati$ lainn'a te!"a%)/ !#%ta&lan(in 'an&

(i!#()/%i #leh "a/!#$a&* "en&)bah $a/t#! e!t)"b)han1b* (an IL1>* 'an& "en#na/ti$/an

"a/!#$a&* a(a &ili!ann'a "en)!)n/an !#()/%i %it#/in #leh T1%el. 9an&&)an (a!i %alah %at)

ata) %e")a %i%te" t#le!an%i ata) "e/ani%"e %i%te" /e/ebalan t)b)h lainn'a "en'ebab/an

en)!)na /#nt!#l en'a/it a)t#i")n 6(i3ela%/an lebih lan3)t (i baah7.

Rea/%i hie!%en%iti$ 'an& be!lebihan* "e"be!i/an tan&&aan /e/ebalan 'an& ti(a/

bai/ )nt)/ (iat)! a(a be!ba&ai "#le/)l anti&en %ehin&&a "en&a/ibat/an ,e(e!a 3a!in&an /e

h#%t. Ini telah (i/la%i$i/a%i/an /e (ala" e"at 3eni% )ta"a "e/ani%"e ,e(e!a 3a!in&an

be!(a%a!/an 9ell (an +##"b% 6Tabel <7. Tie I Pa(a en'a/it* anti&en (i"e(ia%i I&E "e"i,)

!e%#n ana$ila/ti/ 6#l)"e >* Bab ::7. Tie II &an&&)an "elibat/an e"bent)/an antib#(i

te!ha(a 3a!in&an a%li* 'an& (i%eb)t !e%#n %it#t#/%i/* %ee!ti 'an& te!lihat Sin(!#"

9##(a%t)!e. Hie!%en%iti-ita% tie III a(a en'a/it (i%ebab/an #leh /#"le/% i")n 'an&

&a&al )nt)/ "e"be!%ih/an (en&an bena!* %ehin&&a "en'ebab/an ,e(e!a 3a!in&an %ee!ti

'an& te!lihat (en&an SLE. Tie I &an&&)an "elibat/an ,e(e!a 3a!in&an te!t)n(a 'an&

(i"e(ia%i #leh T1li"$#%it e/a.



Table 5 /ell an# %oo$bs %lassi)ica!ion o) I$$une*Me#ia!e# H&e(sensi!i"i! Reac!ions

H&e(sensi!i"i! class P(o!o!&e #iso(#e( I$$une $echanis$

I6Ana&hlac!ic Anah'la@i%* %#"e $#!"% #$

b!#n,hial a%th"a

F#!"ati#n #$ I&E 6,'t#t!#i,7

antib#('i""e(iate !elea%e #$

-a%#a,ti-e a"ine% an( #the!

"e(iat#!% $!#" ba%#hil% an(

"a%t ,ell% $#ll#e( b'

!e,!)it"ent #$ #the!

in$la""at#!' ,ell%

II6%!o!o-ic A)t#i"")ne he"#l'ti, ane"ia*

e!'th!#bla%t#%i% $etali%*

9##(a%t)!e %'n(!#"e

F#!"ati#n #$ I&9* I&Mbin(% t#

anti&en #n ta!&et ,ell %)!$a,e

ha&#,'t#%i% #! l'%i% #$ ta!&et

,ell b' +=*J $!a,ti#n #$

,#"le"ent #! antib#('1

(een(ent ,ell)la! ,'t#t#@i,it'

III6I$$une co$&le-A!th)% !ea,ti#n* %e!)" %i,/ne%%*

SLE* ,e!tain $#!"% #$ a,)te

&l#"e!)l#neh!iti%

Anti&enantib#(' ,#"le@e%

a,ti-ate( ,#"le"ent att!a,te(

ne)t!#hil%!elea%e #$

l'%#%#"al enz'"e% an( #the!

t#@i, "#ietie%. Fail)!e #$

,#"le"ent t# ,lea!

I76%ell*$e#ia!e# +#elae#, T)be!,)l#%i%* ,#nta,t

(e!"atiti%*

t!an%lant !e3e,ti#n

Sen%itize( T l'"h#,'te%

!elea%e #$ l'"h#/ine% an( T1

,ell1"e(iate( ,'t#t#@i,it'

Abb!e-iati#n%0 I&* I"")n#&l#b)lin SLE* %'%te"i, l))% e!'the"at#%)%.

PEN/ARUH TRAUMA8 LUKA BAKAR8 DAN SAKIT KRITIS PADA KEKEBALAN

Sekilas Mo#ulasi Kekebalan Tubuh Se!elah %e#e(a

E$e/ t!a)"a be!at (an l)/a ba/a! %e!in& be!"ani$e%ta%i %eba&ai %in(!#" !e%#n in$la"a%i

%i%te"i/ 6SIRS7 (ii/)ti #leh ne&a!a 'an& !elati$ i"")n#(e!e%%e( %ela"a in$e/%i 'an&

"en&an,a" 3ia (aat te!3a(i. Pe!i#(e e")lihan (a!i e!a(an&an %i%te"i/ (i%eb)t ,#)nte!1!e&)lat#!' anti1in$la""at#!' !e%#n%e 6+ARS7. Seb)ah en&hinaan t!a)"ati% bia%an'a



ini%iat e!a(an&an ne&a!a 'an& a/an "e"bent)/ /e%ei"ban&an anta!a e$e/ "en&)nt)n&/an

e!a(an&an (i/#nt!#l (an e$e/ be!baha'a #ten%ial %ee!ti %in(!#" &an&&)an e!naa%an

(ea%a 6ARDS7 (an %in(!#" (i%$)n&%i ")lti1#!&an 6MODS7 a/ibat e!a(an&an 'an&

ti(a/ te!/en(ali. Ha%il aal n#!"al ,e(e!a "a%%i$ (an %'#/ (aat "en3a(i in$la"a%i !e%#n

'an& be!lebihan* ini bia%an'a (i%eb)t #ne1hit "#(el. Dala" /a%)% lain* !e%#n ini ")n&/in

ha%il (a!i "#(el ()a1hit (i "ana a%ien "ene!i"a aal %ti")l)% in$la"a%i 'an& !elati$

'an& !in&an bia%an'a a/an (i%ele%ai/an* (ii/)ti )/)lan /e()a %ee!ti !#%e()! e"be(ahan

ata) in$e/%i 'an& "en&a!ah /e hie!%ti")la%i (a!i %i%te" /e/ebalan t)b)h. Dala" /e()a

/a%)%* %i%te" /e/ebalan t)b)h baaan te!"a%)/ "a/!#$a&* le)/#%it* %el NK* IL1=* (an

/#"#nen elen&/a 'an& be!lebihan (ia/ti$/an "en'ebab/an SIRS (an MODS.n

Hal %ebali/n'a 3)&a (aat te!3a(i (i "ana !e%#n in$la"a%i aal a(alah !elati$ !in&an

na")n !e%#n e")lihan (itan(ai (en&an i")n#%)!e%i 'an& be!lebihan. Pa%ien ")n&/in

"e"ili/i ,he"#ta@i% 'an& "e"a(ai ne)t!#$il* $a&#%it#%i%* enzi" li%#%#" /#nten* (an le(a/an

e!naa%an. Ini be!i/)t 'an& !elati$ i")n#%)!e%in'a (i ne&a!a t!a)"a ")n&/in "e"be!i/an

/#nt!ib)%i )nt)/ enin&/atan !i%i/# in$e/%i be!i/)t ,e(e!a t!a)"ati%. P!#()/%i i")n#&l#b)lin

(an inte!$e!#n 3at)h (an ban'a/ a%ien "en3a(i ane!&i,. Dala" /#nte/% +ARS be!lebihan*

in$e/%i (an %e%i% "en3a(i lebih ")n&/in (an "enin&/at/an /e"atian. P!#$il %it#/in (an

inte!a/%i a(a a/hi!n'a "enent)/an aa/ah SIRS ata) +ARS a/an te!)3)(.Bebe!aa enelitian "en()/)n& &a&a%an baha !e%#n /e/ebalan (aat (ite/an

(ala" /ea(aan t!a)"a a!ah. A(a b)/ti baha tin&/at bebe!aa "e(iat#! antiin$la"a%i

ala"i* %ee!ti TNF1la!)t !e%et#! (an IL1> anta&#ni% !e%et#! "enin&/at %ela"a >< ha!i

%etelah ,e(e!a t!a)"ati/ 'an& a!ah. A(a tin&/at 'an& lebih tin&&i a(a a%ien (en&an ,e(e!a

'an& lebih a!ah* (an a%ien (en&an tin&/at 'an& lebih tin&&i "e"ili/i "#!talita% 'an& lebih

tin&&i. De"i/ian 3)&a* /e"a")an %el1%el "#n#n)/lea! (a!ah e!i$e! )nt)/ "enan&&ai

en(#t#/%in be!/)!an& a(a a%ien te!l)/a a!ah. Pa(a a%ien (en&an %/#! /ea!ahan ,e(e!a

!ata1!ata 6ISS7 (a!i :J* elea%an %it#/in !#1in$la"a%i 6TNF1a* IL1>b* IL1C* IL1=* IL1>2* (an

IFN1a7 (ala" "enan&&ai !an&%an&an (en&an li##li%a/a!i(a te!ha"bat (iban(in&/an

(en&an /#nt!#l %ehat. Kea(aan ini telah "en)n3)//an %ebel)"n'a baha %etelah l)/a ba/a!*

$)n&%i PMN (aat te!&an&&). +e(e!a t!a)"ati/ 'an& %i&ni$i/an (aat "e"en&a!)hi $)n&%i

le)/#%it (an e/%!e%i %it#/in 'an& "en&a!ah /e bai/ a(a i"")n#a,ti-ati#n (an

i")n#%)!e%i. Bah/an* t)3)an 'an& #ti"al te!ai ")n&/in bai/ (iaha"i (en&an t)3)an

"en&e"bali/an /e%ei"ban&an anta!a i"")n#%ti")lati#n (an i")n#%)!e%i.



Be!(a%a!/an eneliti /e"a")an )nt)/ "en&)/)! "e(iat#! in$la"a%i telah "e"bai/*

a(a ban'a/ enelitian be!)%aha )nt)/ "enent)/an enan(a %e!)" a%ien (en&an !i%i/#

te!tin&&i. Mi%aln'a* !#tein +1!ea/ti$ bia%an'a "enin&/at (ala" ()a ha!i e!ta"a %etelah

,e(e!a t!a)"ati/. Na")n* ti(a/ %e%i$i/ (an bel)" te!b)/ti )nt)/ "e"!e(i/%i /#"li/a%i.

Penan(a lain* !#,al,it#nin* (i!#()/%i (i (ala" ti!#i( (an ti(a/ te!(ete/%i a(a in(i-i()

n#!"al. Me%/i)n "enin&/at %etelah t!a)"a ata) in$e/%i* ti(a/ a(a /#n%en%)%

a(a /e&)naann'a %eba&ai enan(a. TNF1a(alah %alah %at) (a!i !e&)lat#! %ent!al (ala"

!e%#n% $a%e a/)t te!libat (ala" /e"#ta/%i% le)/#%it* (e"a"* hi#ten%i* (an a(he%i %el

en(#tel. Tin&/at tin&&i te!)%1"ene!)% be!h)b)n&an (en&an ha%il 'an& b)!)/. Ke&)naann'a

%eba&ai enan(a telah /#n%i%ten (an en&#batan (en&an anti1TNF1a bel)" te!b)/ti %)/%e%.

IL1> (an IL1= 3)&a telah (ian(al/an %eba&ai enan(a. IL1C (an IL1> ")n&/in lebih (aat

(ian(al/an* (an (ala" %at) %t)(i !a%i# IL1C te!ha(a IL1> (i!e/#"en(a%i/an %eba&ai

enan(a 'an& be!&)na )nt)/ "e"!e(i/%i tin&/at t!a)"a ,e(e!a be!i/)t.

Uku(an I$$unoco$&e!ence

I")nita% 'an& (ie!anta!ai %el ini alin& %e!in& (ie-al)a%i /lini% (en&an "ene"at/an anel

ane!&i (i "ana 3)"lah /e,il (i%)nti//an anti&en )")" a(alah int!a(e!"all'* )nt)/ "elihat

aa/ah in()!a%i te!3a(i (ala" a/t) <= %a"ai G2 3a". Anti&en 'an& )")" (i&)na/an )nt)/

"enilai i")nita% 'an& (ie!anta!ai %el "en,a/) !#tein (a!i tetan)% t#/%#i(* (i$te!i t#@#i(*

+an(i(a* T!i,#h't#n* St!et#,#,,)%* (an P!#te)%. i/a !e%#n ti(a/ te!3a(i (ala" a/t) G2

3a"* a%ien (i/ata/an ane!&i,* (an ")n&/in ti(a/ "a") )nt)/ "e1"#)nt !e%#n /e/ebalan

'an& "e"a(ai en'e!b) (a!i l)a!. Ban'a/ le"ba&a telah be!henti "ela/)/an ini (ala"

h)b)n&ann'a (en&an ( en&)3ian* tetai anel ane!&i teta "et#(e /lini% %)a!a )nt)/

"enent)/an cell mediated a%ien %tat)% /e/ebalan.

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