Efikasi Ekstrak Mitragyna speciosa (Kratom) terhadap Penyembuhan Ulkus Diabetik: Tinjauan Literatur
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Ulkus diabetik, khususnya ulkus kaki diabetik, merupakan komplikasi kronis diabetes melitus yang ditandai oleh inflamasi persisten, stres oksidatif, gangguan angiogenesis, peningkatan risiko infeksi, dan keterlambatan remodelling jaringan. Terapi adjuvan yang berasal dari bahan botani semakin mendapat perhatian karena profil fitokimianya yang kompleks dapat bekerja pada beberapa jalur penyembuhan luka secara bersamaan. Mitragyna speciosa (kratom) merupakan tanaman famili Rubiaceae yang kaya alkaloid dan dilaporkan memiliki aktivitas antiinflamasi, antioksidan, antimikroba, dan pro-regeneratif. Tinjauan literatur ini mengevaluasi bukti yang tersedia mengenai efektivitas ekstrak M. speciosa dibandingkan dengan perawatan luka standar dalam meningkatkan penyembuhan ulkus diabetik.Tinjauan sistematis bergaya PRISMA dilakukan melalui pencarian di internet, yang menghasilkan 521 rekam literatur. Rekam literatur disaring berdasarkan kriteria populasi, intervensi, pembanding, luaran, desain studi, dan atribusi yang telah ditetapkan sebelumnya. Delapan sumber memenuhi kriteria kelayakan dan disintesis secara kualitatif.Tidak ditemukan uji klinis, studi observasional, atau studi in vivo pada luka diabetik yang secara langsung membandingkan ekstrak kratom dengan perawatan luka standar. Bukti spesifik tentang kratom masih terbatas pada studi in vitro dan studi formulasi. Sintesis bukti in vitro yang tersedia melaporkan penekanan tumor necrosis factor-alpha, interleukin-6, cyclooxygenase-2, 5-lipoxygenase, nitric oxide, dan reactive oxygen species, disertai stimulasi migrasi sel dan angiogenesis. Formulasi kratom topikal berbentuk spray film-forming telah dikembangkan, tetapi data efikasinya belum tersedia. Tinjauan sistematis yang lebih luas menunjukkan bahwa adjuvan botani dapat meningkatkan luaran penyembuhan ulkus kaki diabetik, tetapi tinjauan tersebut tidak mencakup kratom. Bukti saat ini mendukung plausibilitas biologis, tetapi belum menetapkan efektivitas yang membandingkan. Formulasi kratom yang terstandar memerlukan validasi in vivo, penilaian hubungan dosis-respons, evaluasi keamanan, serta uji klinis acak dengan kekuatan sampel yang memadai sebelum rekomendasi klinis dapat diberikan.
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