Uji Validitas Hasil Pengukuran Laju Endap Darah Metode Humased 20 Dibandingkan Dengan Metode Westergren Pada Penderita TBC.
Lam Henni P. S., 2006, Pembimbing I : Penny Setyawati M, dr., Sn.PK, M.Kes.
Pembimbing II : Yanti Mulyana, Dra. Ant., DMM, MS.
Laju Endan Darah (LED) adalah nemeriksaan laboratorium yang sering
diminta nara klinisi untuk nemantauan nerjalanan nenyakit, misalnya nada
nenderita tuberkulosis. Pemeriksaan LED yang sering digunakan samnai saat ini
adalah metode Westergren yang dibaca nada jam ke 1 dan 2. Sekarang telah
dinerkenalkan metode nengukuran baru yaitu metode Humased 20 dengan waktu
nemeriksaan lebih singkat, yang dibaca setelah 12 menit. Tujuan nenelitian ini
adalah ingin menguji validitas metode Humased 20 terhadan metode standar
Westergren.
Penelitian dilakukan dengan menggunakan metode eksnerimen deskrintif
analitik komnaratif terhadan 50 orang nenderita tuberkulosis sebagai kelomnok uji
dan 50 orang sehat sebagai kelomnok kontrol. Bahan nemeriksaan yang
digunakan adalah darah vena dengan antikoagulan Na>sitrat 3,8% yang dineriksa
dengan metode Humased 20 dan Westergren. Hasil nemeriksaan dibaca setelah 1
dan 2 jam. Data dianalisis dengan uji t bernasangan yang dilanjutkan dengan uji F.
Rerata hasil nengukuran LED yang dibaca nada 1 jam nertama kelomnok
kontrol dengan metode Humased 20 adalah 6,000 mm/jam ( SB=1,641) dan
dengan metode Westergren adalah 6,160 mm/jam (SB=1,683), sedangkan nada
nenderita tuberkulosis rerata metode Humased 20 adalah 74,360 mm/jam
(SB=28,503) dan rerata metode Westergren adalah 75,460 mm/jam (SB=29,519).
Rerata hasil nengukuran setelah 2 jam nada kelomnok kontrol dengan metode
Humased 20 adalah 18,580 mm (SB=5,526) dan metode Westergren adalah 18,48
mm (SB=5,027), sedangkan nada nenderita tuberkulosis rerata metode Humased
20 adalah 111,180 mm (SB=29,129) dan metode Westergren adalah 110,380 mm
(SB=26,880). Berdasarkan analisis statistik didanatkan hasil nengukuran metode
Humased 20 tidak berbeda bermakna dengan α=0,05.
Kesimnulan: Hasil nemeriksaan metode Humased 20 dibandingkan dengan
metode Westergren adalah valid.
Kata kunci: LED, Humased 20, Westergren
iv
!
Lam Henni P. S., 2006,
"
#
Tutor I : Penny Setyawati M, dr., Sn.PK, M.Kes.
Tutor II : Yanti Mulyana, Dra. Ant., DMM, MS.
Erythrocyte Sedimentation Rate (ESR) is a laboratory examination which
often requested by the clinics to observe disease progress, for example
tuberculosis. ESR examination which often used until now is Westergren, read
after 1 and 2 hours. Now new method has been introduced, Humased 20 with
shorter examination time, read after 12 minutes. The purpose of this research was
for the validity test of Humased 20 compared with Westergren method.
The research used descriptive analytic with comparative study. The subject of
this research was vein blood of 50 tuberculosis patients as group of examination
and 50 healthy persons as group of control. The blood was mixed with
anticoagulant Sodium Citrate 3,8% then examined by Humased 20 and
Westergren. The result was analyzed by paired samples t test and F test.
The average of the result at first hour in group of control with Humased 20 is
6,000 mm/hour (SD=1,641) and Westergren is 6,160 mm/hour (SD=1,683),
whereas the average of Humased 20 in group of examination is 74,360 mm/hour
(SD=28,503) and Westergren is 75,460 mm/hour (SD=29,519). The average of
the result at second hour in group of control with Humased 20 is 18,580 mm
(SD=5,526) and Westergren is 18,480 mm (SD=5,027), whereas the average of
Humased 20 in group of examination is 111,180 (SD=29,129) and Westergren is
110,380 mm (SD=26,882). Based on statistic test analyze, the result of Humased
20 is not different of Westergren with α=0,05.
Conclusion: Theresult of examination with Humased 20 method is valid.
Keyword : ESR, Humased 20, Westergren
v
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1.1. Latar Belakang ............................................................................................ 1
1.2. Identifikasi Masalah.................................................................................... 3
1.3. Maksud dan Tujuan Penelitian.................................................................... 3
1.3.1. Maksud Penelitian.............................................................................. 3
1.3.2. Tujuan Penelitian ............................................................................... 3
1.4. Manfaat Penelitian ...................................................................................... 3
1.4.1. Manfaat Akademis ............................................................................. 3
1.4.2. Manfaat Praktis .................................................................................. 4
1.5. Kerangka nemikiran.................................................................................... 4
1.6. Hinotesis...................................................................................................... 5
1.7. Metode Penelitian........................................................................................ 5
1.8. Lokasi dan Waktu ....................................................................................... 5
1.8.1. Lokasi................................................................................................. 5
1.8.2. Waktu ................................................................................................. 5
viii
2.1. Definisi Laju Endan Darah.......................................................................... 6
2.2. Prinsin Pemeriksaan LED ........................................................................... 6
2.3. Faktor>faktor yang memnengaruhi LED..................................................... 7
2.3.1. Faktor Eritrosit ................................................................................... 7
2.3.2. Faktor Plasma..................................................................................... 8
2.3.3. Faktor Teknis ..................................................................................... 9
2.3.4. Faktor lain ......................................................................................... 10
2.4. Metode>metode Pengukuran LED.............................................................. 12
2.4.1. Metode ICSH .................................................................................... 13
2.4.2. Metode Westergren ........................................................................... 15
2.4.3. Metode Wintrobe .............................................................................. 18
2.4.4. Metode Mikro Sedimentasi Landau.................................................. 19
2.4.5. Zeta Sedimentation Ratio (ZSE)........................................................ 21
2.4.6. VESMATIC ...................................................................................... 22
2.4.7. SEDIMAT ......................................................................................... 23
2.4.8. Humased 20....................................................................................... 24
2.5. Nilai Rujukan Pemeriksaan LED ............................................................... 25
2.6. Asnek Klinik Pemeriksaan LED ................................................................ 29
2.7. Tuberkulosis............................................................................................... 31
2.7.1. Enidemiologi Tuberkulosis .............................................................. 31
2.7.2. Etiologi............................................................................................. 32
2.7.3. Patogenesis....................................................................................... 33
2.7.4. Gejala Klinik .................................................................................... 34
2.7.5. Faktor Resiko ................................................................................... 35
2.7.5.1. Umur ..................................................................................... 35
2.7.5.2. Jenis Kelamin........................................................................ 35
2.7.5.3. Pendidikan............................................................................. 36
2.7.5.4. Pekerjaan............................................................................... 36
2.7.5.5. Status Sosial Ekonomi .......................................................... 37
2.7.5.6. Merokok ................................................................................ 37
ix
2.7.6. Pemeriksaan Penunjang .................................................................... 37
2.7.6.1. Pemeriksaan Radiologis ........................................................ 37
2.7.6.2. Pemeriksaan Bakteriologis.................................................... 38
2.7.8. Obat Anti Tuberkulosis (OAT) ......................................................... 39
3.1. Bentuk dan Rancangan Penelitian.............................................................. 42
3.2. Subyek Penelitian....................................................................................... 42
3.3. Definisi Onerasional................................................................................... 43
3.4. Variabel Penelitian..................................................................................... 43
3.5. Bahan nemeriksaan .................................................................................... 43
3.6. Reagen dan Alat ......................................................................................... 44
3.6.1. Metode Westergren ........................................................................... 44
3.6.2. Metode Humased 20 ......................................................................... 44
3.6.3. Pemeriksaan Hb Sahli ....................................................................... 44
3.6. Prosedur Kerja............................................................................................ 44
3.6.1. Prosedur Persianan Bahan Percobaan ............................................... 44
3.6.2. Metode Pemeriksaan Westergren...................................................... 45
3.6.3. Metode Pemeriksaan Humased 20.................................................... 46
3.6.4. Metode Pemeriksaan Hb Sahli .......................................................... 46
3.7. Analisis Data dan Uji Hinotesis ................................................................. 47
3.7.1. Analisis Data ..................................................................................... 47
3.7.2. Uji Hinotesis ..................................................................................... 48
4.1. Hasil dan Uji Hinotesis .............................................................................. 49
4.1.1. Hasil Pemeriksaan LED nada Kelomnok Kontrol ............................ 49
4.1.1.1. Uji Hinotesis Hasil Pemeriksaan Jam Pertama ..................... 49
4.1.1.2. Uji Hinotesis Hasil Pemeriksaan Jam Kedua........................ 51
x
4.1.2. Hasil Pemeriksaan LED nada Kelomnok Uji.................................... 52
4.1.1.1. Uji Hinotesis Hasil Pemeriksaan Jam Pertama ..................... 52
4.1.1.2. Uji Hinotesis Hasil Pemeriksaan Jam Kedua........................ 54
4.2. Keadaan Kelomnok Uji.............................................................................. 55
4.3. Pembahasan................................................................................................ 57
5.1. Kesimnulan ................................................................................................ 60
5.2. Saran........................................................................................................... 60
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""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" &
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" '
xi
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Tabel 2.1. Kontribusi Relatif Protein Fase Akut terhadan Agregasi Eritrosit .. 9
Tabel 2.2. Faktor>Faktor yang Memnengaruhi LED ........................................ 12
Tabel 2.3. Nilai Normal LED menurut metode standar ICSH.......................... 27
Tabel 2.4. Nilai Normal Pemeriksaan LED ...................................................... 27
Tabel 2.5. Nilai LED (mm) untuk Verifikasi dan Perbandingan
Metode Pemeriksaan Rutin dengan Metode Pengukuran
LED Standar ICSH........................................................................... 28
Tabel 4.1. Nilai LED Humased 20 dan Westergren nada
Kelomnok Kontrol ........................................................................... 49
Tabel 4.2. Nilai LED Humased 20 dan Westergren nada
Kelomnok Uji................................................................................... 52
Tabel 4.3. Distribusi Jenis Kelamin Penderita Tuberkulosis ............................ 55
Tabel 4.4. Distribusi Hb nada Penderita Tuberkulosis ..................................... 55
Tabel 4.5. Distribusi Keluhan Utama Penderita Tuberkulosis.......................... 56
Tabel 4.6. Distribusi keluhan Penderita Tuberkulosis ...................................... 56
xii
Halaman
Gambar 2.1. Formasi Rouleaux nada Sediaan Anus Darah Teni....................... 8
Gambar 2.2. Pengukuran LED dengan Metode Westergren............................. 18
Gambar 2.3. nengukuran LED drngan Metode Wintrobe................................. 20
Gambar 2.4. Pengukuran LED dengan Metode Sedimentasi Landau............... 22
Gambar 2.5. Zetafuge........................................................................................ 23
Gambar 2.6. Alat Pemeriksaan LED dengan VES>MATIC ............................. 24
Gambar 2.7. Sedimat 15.................................................................................... 25
Gambar 2.8. Alat Pemeriksaan LED dan Tabung Humased 20........................ 26
Gambar 2.9. Mycobacterium tuberculosis dengan
newarnaan Ziehl Neelsen ............................................................. 33
xiii
Halaman
Lamniran 1 Hasil Penelitian nada Kelomnok Kontrol..................................... 64
Lamniran 2 Hasil Uji Sktastistik Hasil Pemeriksaan LED jam Pertama
nada Kelomnok Kontrol............................................................... 65
Lamniran 3 Hasil Uji Statistik Hasil Pemeriksaan LED jam Kedua
nada Kelomnok Kontrol............................................................... 67
Lamniran 4 Hasil Penelitian nada Kelomnok Uji ............................................ 69
Lamniran 5 Hasil Uji Sktastistik Hasil Pemeriksaan LED jam nertama
nada Kelomnok Uji ...................................................................... 70
Lamniran 6 Hasil Uji Statistik Hasil Pemeriksaan LED jam Kedua
nada Kelomnok Uji ...................................................................... 72
Lamniran 7 Informed Consent ......................................................................... 74
Lamniran 8 Kuesioner Penelitian..................................................................... 75
xiv
76
4+ >
-
Nama
: Lam Henni Purnomo Sakti
Nrp
: 0210105
Tempat, Tanggal Lahir
: Bandar Lampung, 13 Agustus 1984
Alamat
: Jl. Sarimanis No. 7/11 Sarijadi Blok 15, Bandung
Riwayat Pendidikan
Tahun 1996
: Lulus SD Xaverius Telukbetung
Tahun 1999
: Lulus SLTP Xaverius Telukbetung
Tahun 2002
: Lulus SMU Xaverius Bandar Lampung
Tahun 20022sekarang
: Mahasiswa Fakultas Kedokteran
Universitas Kristen Maranatha
64
#'
'
% (#'( %(
( 5##7
No
Usia (th)
Humased 1 jam
Westergren 1 jam
Humased 2 jam
Westergren 2 jam
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
Rata2
20
19
20
18
18
22
23
25
17
24
19
17
21
22
25
23
33
24
22
18
19
24
21
22
45
22
21
23
36
29
40
45
35
38
37
25
28
42
44
27
28
28
27
30
43
32
40
35
25
25
5
6
6
6
6
4
6
6
5
6
6
4
4
8
1
4
7
3
7
3
6
6
7
6
9
10
7
6
6
8
6
8
5
5
7
8
8
5
6
5
5
6
6
8
6
5
9
7
6
5
6,00
5
8
6
6
7
5
6
5
6
5
6
4
4
8
2
4
5
2
8
5
5
6
7
6
10
10
7
5
6
8
6
8
6
5
8
8
8
5
6
8
6
5
5
8
6
6
8
6
8
5
6,16
13
22
24
20
18
7
28
22
20
22
18
11
7
29
2
13
29
10
20
14
10
20
22
20
20
23
20
20
24
20
18
18
24
20
22
20
24
20
18
20
24
20
18
16
18
20
16
15
20
10
18,58
10
20
20
20
20
7
24
20
20
22
16
14
7
29
4
13
29
18
18
14
10
20
20
18
20
20
20
20
24
24
20
18
22
20
22
20
24
18
21
20
24
18
18
16
18
20
20
16
18
10
18,4820
65
#'
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
6,000
50
1,64130
0,23121
1
Westergren 1
6.160
50
1,68256
0,23795
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,824
Sig.
0,000
- #'
Pair 1
Humased 12Westergren1
Paired Differences
Mean
20,16000
Std. Deviation
0,93372
Std. Err. Mean
0,13205
95% Convidence Interval L
Of Difference
U
t
2 0,42536
0,10536
1.0121
49
df
Sig.(22tailed)
0,231
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan rata2
rata LED hasil pengukuran metode Westergren
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2rata
LED hasil pengukuran metode Westergren
66
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 21,121, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
0( 8
:
Levene statistic
df1
df2
Sig.
0,576
1
98
0,450
0,05, Ho diterima
67
#'
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
18,580
50
5,52578
0,78146
1
Westergren 1
18,480
50
5,02743
0,71099
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,925
Sig.
0,000
- #'
Pair 1
Humased 12Westergren1
Paired Differences
Mean
0,10000
Std. Deviation
2,10199
Std. Err. Mean
0,29727
95% Convidence Interval
L
2 0,49738
Of Difference
U
0,69738
t
20,336
df
49
Sig. 22tailed)
20,738
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan
rata2rata LED hasil pengukuran metode Westergren
68
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2rata
LED hasil pengukuran metode Westergren
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 0,336, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
0( 8
:
Levene statistic
df1
df2
Sig.
0,482
1
98
0,489
0,05, Ho diterima
69
#'
"
70
#'
$
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
74,3600
50
28,50260
4,03088
1
Westergren 1
75,4600
50
29,51924
4,17468
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,957
Sig.
0,000
- #'
Pair 1
Humased 12Westergren1
Paired Differences
Mean
21,10000
Std. Deviation
8,60055
Std. Err. Mean
1,21630
95% Convidence Interval L
Of Difference
U
t
2 3,54425
1,34425
2 0,904
df
49
Sig.(22tailed)
0,370
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan
rata2rata LED hasil pengukuran metode Westergren
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2rata
LED hasil pengukuran metode Westergren
71
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 20,904, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
Levene statistic
0( 8
df1
0,293
:
df2
1
Sig.
98
0,589
0,05, Ho diterima
72
#'
&
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
111,1800
50
29,19232
4,12842
1
Westergren 1
110,3800
50
26,88212
3,80171
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,980
Sig.
,000
- #'
Pair 1
Humased12Westergren1
Paired Differences
Mean
0,80000
Std. Deviation
6,11455
Std. Err. Mean
0,86473
95% Convidence Interval
L
20,93774
Of Difference
U
2,53774
t
0,925
df
49
Sig. (22tailed)
0,359
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan
rata2rata LED hasil pengukuran metode Westergren
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2
rata LED hasil pengukuran metode Westergren
73
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 0,925, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
0( 8
:
Levene statistic
df1
df2
Sig.
0,310
1
98
0,579
0,05, Ho diterima
74
#'
)
.
Pembimbing II : Yanti Mulyana, Dra. Ant., DMM, MS.
Laju Endan Darah (LED) adalah nemeriksaan laboratorium yang sering
diminta nara klinisi untuk nemantauan nerjalanan nenyakit, misalnya nada
nenderita tuberkulosis. Pemeriksaan LED yang sering digunakan samnai saat ini
adalah metode Westergren yang dibaca nada jam ke 1 dan 2. Sekarang telah
dinerkenalkan metode nengukuran baru yaitu metode Humased 20 dengan waktu
nemeriksaan lebih singkat, yang dibaca setelah 12 menit. Tujuan nenelitian ini
adalah ingin menguji validitas metode Humased 20 terhadan metode standar
Westergren.
Penelitian dilakukan dengan menggunakan metode eksnerimen deskrintif
analitik komnaratif terhadan 50 orang nenderita tuberkulosis sebagai kelomnok uji
dan 50 orang sehat sebagai kelomnok kontrol. Bahan nemeriksaan yang
digunakan adalah darah vena dengan antikoagulan Na>sitrat 3,8% yang dineriksa
dengan metode Humased 20 dan Westergren. Hasil nemeriksaan dibaca setelah 1
dan 2 jam. Data dianalisis dengan uji t bernasangan yang dilanjutkan dengan uji F.
Rerata hasil nengukuran LED yang dibaca nada 1 jam nertama kelomnok
kontrol dengan metode Humased 20 adalah 6,000 mm/jam ( SB=1,641) dan
dengan metode Westergren adalah 6,160 mm/jam (SB=1,683), sedangkan nada
nenderita tuberkulosis rerata metode Humased 20 adalah 74,360 mm/jam
(SB=28,503) dan rerata metode Westergren adalah 75,460 mm/jam (SB=29,519).
Rerata hasil nengukuran setelah 2 jam nada kelomnok kontrol dengan metode
Humased 20 adalah 18,580 mm (SB=5,526) dan metode Westergren adalah 18,48
mm (SB=5,027), sedangkan nada nenderita tuberkulosis rerata metode Humased
20 adalah 111,180 mm (SB=29,129) dan metode Westergren adalah 110,380 mm
(SB=26,880). Berdasarkan analisis statistik didanatkan hasil nengukuran metode
Humased 20 tidak berbeda bermakna dengan α=0,05.
Kesimnulan: Hasil nemeriksaan metode Humased 20 dibandingkan dengan
metode Westergren adalah valid.
Kata kunci: LED, Humased 20, Westergren
iv
!
Lam Henni P. S., 2006,
"
#
Tutor I : Penny Setyawati M, dr., Sn.PK, M.Kes.
Tutor II : Yanti Mulyana, Dra. Ant., DMM, MS.
Erythrocyte Sedimentation Rate (ESR) is a laboratory examination which
often requested by the clinics to observe disease progress, for example
tuberculosis. ESR examination which often used until now is Westergren, read
after 1 and 2 hours. Now new method has been introduced, Humased 20 with
shorter examination time, read after 12 minutes. The purpose of this research was
for the validity test of Humased 20 compared with Westergren method.
The research used descriptive analytic with comparative study. The subject of
this research was vein blood of 50 tuberculosis patients as group of examination
and 50 healthy persons as group of control. The blood was mixed with
anticoagulant Sodium Citrate 3,8% then examined by Humased 20 and
Westergren. The result was analyzed by paired samples t test and F test.
The average of the result at first hour in group of control with Humased 20 is
6,000 mm/hour (SD=1,641) and Westergren is 6,160 mm/hour (SD=1,683),
whereas the average of Humased 20 in group of examination is 74,360 mm/hour
(SD=28,503) and Westergren is 75,460 mm/hour (SD=29,519). The average of
the result at second hour in group of control with Humased 20 is 18,580 mm
(SD=5,526) and Westergren is 18,480 mm (SD=5,027), whereas the average of
Humased 20 in group of examination is 111,180 (SD=29,129) and Westergren is
110,380 mm (SD=26,882). Based on statistic test analyze, the result of Humased
20 is not different of Westergren with α=0,05.
Conclusion: Theresult of examination with Humased 20 method is valid.
Keyword : ESR, Humased 20, Westergren
v
!
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1.1. Latar Belakang ............................................................................................ 1
1.2. Identifikasi Masalah.................................................................................... 3
1.3. Maksud dan Tujuan Penelitian.................................................................... 3
1.3.1. Maksud Penelitian.............................................................................. 3
1.3.2. Tujuan Penelitian ............................................................................... 3
1.4. Manfaat Penelitian ...................................................................................... 3
1.4.1. Manfaat Akademis ............................................................................. 3
1.4.2. Manfaat Praktis .................................................................................. 4
1.5. Kerangka nemikiran.................................................................................... 4
1.6. Hinotesis...................................................................................................... 5
1.7. Metode Penelitian........................................................................................ 5
1.8. Lokasi dan Waktu ....................................................................................... 5
1.8.1. Lokasi................................................................................................. 5
1.8.2. Waktu ................................................................................................. 5
viii
2.1. Definisi Laju Endan Darah.......................................................................... 6
2.2. Prinsin Pemeriksaan LED ........................................................................... 6
2.3. Faktor>faktor yang memnengaruhi LED..................................................... 7
2.3.1. Faktor Eritrosit ................................................................................... 7
2.3.2. Faktor Plasma..................................................................................... 8
2.3.3. Faktor Teknis ..................................................................................... 9
2.3.4. Faktor lain ......................................................................................... 10
2.4. Metode>metode Pengukuran LED.............................................................. 12
2.4.1. Metode ICSH .................................................................................... 13
2.4.2. Metode Westergren ........................................................................... 15
2.4.3. Metode Wintrobe .............................................................................. 18
2.4.4. Metode Mikro Sedimentasi Landau.................................................. 19
2.4.5. Zeta Sedimentation Ratio (ZSE)........................................................ 21
2.4.6. VESMATIC ...................................................................................... 22
2.4.7. SEDIMAT ......................................................................................... 23
2.4.8. Humased 20....................................................................................... 24
2.5. Nilai Rujukan Pemeriksaan LED ............................................................... 25
2.6. Asnek Klinik Pemeriksaan LED ................................................................ 29
2.7. Tuberkulosis............................................................................................... 31
2.7.1. Enidemiologi Tuberkulosis .............................................................. 31
2.7.2. Etiologi............................................................................................. 32
2.7.3. Patogenesis....................................................................................... 33
2.7.4. Gejala Klinik .................................................................................... 34
2.7.5. Faktor Resiko ................................................................................... 35
2.7.5.1. Umur ..................................................................................... 35
2.7.5.2. Jenis Kelamin........................................................................ 35
2.7.5.3. Pendidikan............................................................................. 36
2.7.5.4. Pekerjaan............................................................................... 36
2.7.5.5. Status Sosial Ekonomi .......................................................... 37
2.7.5.6. Merokok ................................................................................ 37
ix
2.7.6. Pemeriksaan Penunjang .................................................................... 37
2.7.6.1. Pemeriksaan Radiologis ........................................................ 37
2.7.6.2. Pemeriksaan Bakteriologis.................................................... 38
2.7.8. Obat Anti Tuberkulosis (OAT) ......................................................... 39
3.1. Bentuk dan Rancangan Penelitian.............................................................. 42
3.2. Subyek Penelitian....................................................................................... 42
3.3. Definisi Onerasional................................................................................... 43
3.4. Variabel Penelitian..................................................................................... 43
3.5. Bahan nemeriksaan .................................................................................... 43
3.6. Reagen dan Alat ......................................................................................... 44
3.6.1. Metode Westergren ........................................................................... 44
3.6.2. Metode Humased 20 ......................................................................... 44
3.6.3. Pemeriksaan Hb Sahli ....................................................................... 44
3.6. Prosedur Kerja............................................................................................ 44
3.6.1. Prosedur Persianan Bahan Percobaan ............................................... 44
3.6.2. Metode Pemeriksaan Westergren...................................................... 45
3.6.3. Metode Pemeriksaan Humased 20.................................................... 46
3.6.4. Metode Pemeriksaan Hb Sahli .......................................................... 46
3.7. Analisis Data dan Uji Hinotesis ................................................................. 47
3.7.1. Analisis Data ..................................................................................... 47
3.7.2. Uji Hinotesis ..................................................................................... 48
4.1. Hasil dan Uji Hinotesis .............................................................................. 49
4.1.1. Hasil Pemeriksaan LED nada Kelomnok Kontrol ............................ 49
4.1.1.1. Uji Hinotesis Hasil Pemeriksaan Jam Pertama ..................... 49
4.1.1.2. Uji Hinotesis Hasil Pemeriksaan Jam Kedua........................ 51
x
4.1.2. Hasil Pemeriksaan LED nada Kelomnok Uji.................................... 52
4.1.1.1. Uji Hinotesis Hasil Pemeriksaan Jam Pertama ..................... 52
4.1.1.2. Uji Hinotesis Hasil Pemeriksaan Jam Kedua........................ 54
4.2. Keadaan Kelomnok Uji.............................................................................. 55
4.3. Pembahasan................................................................................................ 57
5.1. Kesimnulan ................................................................................................ 60
5.2. Saran........................................................................................................... 60
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" &
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" '
xi
!
Tabel 2.1. Kontribusi Relatif Protein Fase Akut terhadan Agregasi Eritrosit .. 9
Tabel 2.2. Faktor>Faktor yang Memnengaruhi LED ........................................ 12
Tabel 2.3. Nilai Normal LED menurut metode standar ICSH.......................... 27
Tabel 2.4. Nilai Normal Pemeriksaan LED ...................................................... 27
Tabel 2.5. Nilai LED (mm) untuk Verifikasi dan Perbandingan
Metode Pemeriksaan Rutin dengan Metode Pengukuran
LED Standar ICSH........................................................................... 28
Tabel 4.1. Nilai LED Humased 20 dan Westergren nada
Kelomnok Kontrol ........................................................................... 49
Tabel 4.2. Nilai LED Humased 20 dan Westergren nada
Kelomnok Uji................................................................................... 52
Tabel 4.3. Distribusi Jenis Kelamin Penderita Tuberkulosis ............................ 55
Tabel 4.4. Distribusi Hb nada Penderita Tuberkulosis ..................................... 55
Tabel 4.5. Distribusi Keluhan Utama Penderita Tuberkulosis.......................... 56
Tabel 4.6. Distribusi keluhan Penderita Tuberkulosis ...................................... 56
xii
Halaman
Gambar 2.1. Formasi Rouleaux nada Sediaan Anus Darah Teni....................... 8
Gambar 2.2. Pengukuran LED dengan Metode Westergren............................. 18
Gambar 2.3. nengukuran LED drngan Metode Wintrobe................................. 20
Gambar 2.4. Pengukuran LED dengan Metode Sedimentasi Landau............... 22
Gambar 2.5. Zetafuge........................................................................................ 23
Gambar 2.6. Alat Pemeriksaan LED dengan VES>MATIC ............................. 24
Gambar 2.7. Sedimat 15.................................................................................... 25
Gambar 2.8. Alat Pemeriksaan LED dan Tabung Humased 20........................ 26
Gambar 2.9. Mycobacterium tuberculosis dengan
newarnaan Ziehl Neelsen ............................................................. 33
xiii
Halaman
Lamniran 1 Hasil Penelitian nada Kelomnok Kontrol..................................... 64
Lamniran 2 Hasil Uji Sktastistik Hasil Pemeriksaan LED jam Pertama
nada Kelomnok Kontrol............................................................... 65
Lamniran 3 Hasil Uji Statistik Hasil Pemeriksaan LED jam Kedua
nada Kelomnok Kontrol............................................................... 67
Lamniran 4 Hasil Penelitian nada Kelomnok Uji ............................................ 69
Lamniran 5 Hasil Uji Sktastistik Hasil Pemeriksaan LED jam nertama
nada Kelomnok Uji ...................................................................... 70
Lamniran 6 Hasil Uji Statistik Hasil Pemeriksaan LED jam Kedua
nada Kelomnok Uji ...................................................................... 72
Lamniran 7 Informed Consent ......................................................................... 74
Lamniran 8 Kuesioner Penelitian..................................................................... 75
xiv
76
4+ >
-
Nama
: Lam Henni Purnomo Sakti
Nrp
: 0210105
Tempat, Tanggal Lahir
: Bandar Lampung, 13 Agustus 1984
Alamat
: Jl. Sarimanis No. 7/11 Sarijadi Blok 15, Bandung
Riwayat Pendidikan
Tahun 1996
: Lulus SD Xaverius Telukbetung
Tahun 1999
: Lulus SLTP Xaverius Telukbetung
Tahun 2002
: Lulus SMU Xaverius Bandar Lampung
Tahun 20022sekarang
: Mahasiswa Fakultas Kedokteran
Universitas Kristen Maranatha
64
#'
'
% (#'( %(
( 5##7
No
Usia (th)
Humased 1 jam
Westergren 1 jam
Humased 2 jam
Westergren 2 jam
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
Rata2
20
19
20
18
18
22
23
25
17
24
19
17
21
22
25
23
33
24
22
18
19
24
21
22
45
22
21
23
36
29
40
45
35
38
37
25
28
42
44
27
28
28
27
30
43
32
40
35
25
25
5
6
6
6
6
4
6
6
5
6
6
4
4
8
1
4
7
3
7
3
6
6
7
6
9
10
7
6
6
8
6
8
5
5
7
8
8
5
6
5
5
6
6
8
6
5
9
7
6
5
6,00
5
8
6
6
7
5
6
5
6
5
6
4
4
8
2
4
5
2
8
5
5
6
7
6
10
10
7
5
6
8
6
8
6
5
8
8
8
5
6
8
6
5
5
8
6
6
8
6
8
5
6,16
13
22
24
20
18
7
28
22
20
22
18
11
7
29
2
13
29
10
20
14
10
20
22
20
20
23
20
20
24
20
18
18
24
20
22
20
24
20
18
20
24
20
18
16
18
20
16
15
20
10
18,58
10
20
20
20
20
7
24
20
20
22
16
14
7
29
4
13
29
18
18
14
10
20
20
18
20
20
20
20
24
24
20
18
22
20
22
20
24
18
21
20
24
18
18
16
18
20
20
16
18
10
18,4820
65
#'
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
6,000
50
1,64130
0,23121
1
Westergren 1
6.160
50
1,68256
0,23795
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,824
Sig.
0,000
- #'
Pair 1
Humased 12Westergren1
Paired Differences
Mean
20,16000
Std. Deviation
0,93372
Std. Err. Mean
0,13205
95% Convidence Interval L
Of Difference
U
t
2 0,42536
0,10536
1.0121
49
df
Sig.(22tailed)
0,231
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan rata2
rata LED hasil pengukuran metode Westergren
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2rata
LED hasil pengukuran metode Westergren
66
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 21,121, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
0( 8
:
Levene statistic
df1
df2
Sig.
0,576
1
98
0,450
0,05, Ho diterima
67
#'
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
18,580
50
5,52578
0,78146
1
Westergren 1
18,480
50
5,02743
0,71099
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,925
Sig.
0,000
- #'
Pair 1
Humased 12Westergren1
Paired Differences
Mean
0,10000
Std. Deviation
2,10199
Std. Err. Mean
0,29727
95% Convidence Interval
L
2 0,49738
Of Difference
U
0,69738
t
20,336
df
49
Sig. 22tailed)
20,738
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan
rata2rata LED hasil pengukuran metode Westergren
68
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2rata
LED hasil pengukuran metode Westergren
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 0,336, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
0( 8
:
Levene statistic
df1
df2
Sig.
0,482
1
98
0,489
0,05, Ho diterima
69
#'
"
70
#'
$
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
74,3600
50
28,50260
4,03088
1
Westergren 1
75,4600
50
29,51924
4,17468
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,957
Sig.
0,000
- #'
Pair 1
Humased 12Westergren1
Paired Differences
Mean
21,10000
Std. Deviation
8,60055
Std. Err. Mean
1,21630
95% Convidence Interval L
Of Difference
U
t
2 3,54425
1,34425
2 0,904
df
49
Sig.(22tailed)
0,370
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan
rata2rata LED hasil pengukuran metode Westergren
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2rata
LED hasil pengukuran metode Westergren
71
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 20,904, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
Levene statistic
0( 8
df1
0,293
:
df2
1
Sig.
98
0,589
0,05, Ho diterima
72
#'
&
-
, #
# '
% (#'( %(
(
3 '
- #'
-
:
Mean
N
Std. Deviation
Std.Err. Mean
Pair
Humased 1
111,1800
50
29,19232
4,12842
1
Westergren 1
110,3800
50
26,88212
3,80171
- #'
2(
(
N
Pair 1
Humased 1& Westergren 1
Correlation
50
0,980
Sig.
,000
- #'
Pair 1
Humased12Westergren1
Paired Differences
Mean
0,80000
Std. Deviation
6,11455
Std. Err. Mean
0,86473
95% Convidence Interval
L
20,93774
Of Difference
U
2,53774
t
0,925
df
49
Sig. (22tailed)
0,359
Hipotesis statistik:
Ho: Rata2rata LED hasil pengukuran Humased 20 tidak berbeda dengan
rata2rata LED hasil pengukuran metode Westergren
H1: Rata2rata LED hasil pengukuran Humased 20 berbeda dengan rata2
rata LED hasil pengukuran metode Westergren
73
Hasil percobaan tersebut diuji dengan kriteria uji sebagai berikut:
Tolak Ho bila t hitung > t tabel dan terima dalam hal lainnya.
t hitung= 0,925, t tabel= 2,010
t hitung < t tabel,
Ho diterima
.
(
(#(
0( 8
:
Levene statistic
df1
df2
Sig.
0,310
1
98
0,579
0,05, Ho diterima
74
#'
)
.