PERBEDAAN PERUBAHAN KADAR KOLINESTERASE SERUM PADA PENDERITA SIROSIS HATI YANG DITERAPI DENGAN SIMVASTATIN 20 mg DIBANDINGKAN DENGAN SIMVASTATIN 10 mg

FERI NIRANTARA S, Prof. dr. Siti Nurdjanah, M. Kes., Sp.PD-KGEH.; DR. dr. Neneng Ratnasari, Sp.PD-KGEH

2018 | Tesis-Spesialis | ILMU PENYAKIT DALAM

Latar Belakang. Sirosis hati merupakan penyakit yang memiliki morbiditas dan mortalitas yang cukup tinggi baik di dunia maupun di Indonesia. Saat ini banyak dikembangkan terapi yang mampu memperbaiki kondisi sirosis hati, salah satunya adalah simvastatin. Pemberian simvastatin dapat meningkatkan regenerasi sel hati dan memperbaiki disfungsi endotel pada pembuluh darah hati pada pasien sirosis sehingga dapat menurunkan tingkat fibrosis dan memperbaiki fungsi sintesisnya. Kadar kolinesterase (ChE) serum merupakan penanda paling spesifik terhadap fungsi sintesis hati. Tujuan Penelitian. Mengetahui perbedaan perubahan kadar ChE serum pada pasien sirosis hati yang diterapi dengan simvastatin 20mg dibandingkan dengan 10mg selama 3 bulan. Metode. Desain penelitian menggunakan uji klinis acak tersamar ganda dilaksanakan di poli gastroenterohepatologi RSUP Dr. Sardjito Yogyakarta mulai Januari-Juli 2018. Subyek penelitian terdiri dari kelompok yang diberi simvastatin 10mg/hari dan kelompok yang diberi simvastatin 20mg/hari selama 3 bulan. Selama penelitian dilakukan monitoring setiap bulan terhadap kepatuhan konsumsi obat dan efek samping. Analisis data untuk uji statistik dilakukan dengan uji T tidak berpasangan, uji Mann Whitney, uji Chi-square., dan uji Friedman. Hasil Penelitian. Sebanyak 38 subyek mengikuti penelitian. Pemberian simvastatin 20mg dibandingkan 10mg selama 3 bulan menunjukkan perbedaan perubahan kadar ChE serum yang tidak bermakna (p=0,692). Masing-masing kelompok mengalami penurunan kadar ChE serum (03= -0,30 (-1,9-3,0) kelompok simvastatin 10mg; E03= -0,30 (-3,0-2,2) kelompok simvastatin 20mg). Kesimpulan. Tidak didapatkan perbedaan perubahan kadar kolinesterase serum yang bermakna pada penderita sirosis hati yang diterapi dengan simvastatin 20mg per hari dibandingkan dengan simvastatin 10mg per hari selama 3 bulan.

Background. Hepatic cirrhosis has relatively high mortality and morbidity in Indonesia. Recently, many novel therapies are being developed to improve hepatic condition, including simvastatin. Simvastatin improves hepatic cell regeneration, endothelial dysfunction of hepatic vascular system, grade of fibrosis, and its synthetic function. Serum cholinesterase (ChE) level is the most specific marker for hepatic synthesis function. Objective. To examine the difference of serum cholinesterase changes in hepatic cirrhosis patients treated with simvastatin 20mg compared with simvastatin 10mg for 3 months. Methods. This double-blind randomized controlled trial study was conducted in Gastroenterohepathology outpatient clinic of Dr. Sardjito General Hospital from January to July 2018. Subjects were assigned to group treated with simvastatin 10mg/day and group treated with simvastatin 20 mg/day for 3 months. Monitoring of patients compliances and adverse effects was conducted monthly. Statistical analysis was applied using independent T-test, Mann Whitney, Chi-square, and Friedman test. Results. 38 subjects were included in this study. There was no significant difference of serum cholinesterase changes in control and treatment group (p=0,692). Each group reported a decrease in serum ChE levels (E03 = -0,30 (-1,9-3,0) simvastatin 10mg group ; E03 = -0,30 (-3,0-2,2) simvastatin 20mg group). Conclusion. There was no significant difference of serum cholinesterase changes in hepatic cirrhosis patients treated with simvastatin 20mg/day compared to simvastatin 10mg/day for 3 months.

Kata Kunci : Sirosis hati, kolinesterase, simvastatin, hepatic cirrhosis, cholinesterase