Gambaran Klinis Kelainan Hepar & Perbandingan Nilai Laboratorium Fungsi serta Penanda Kerusakan Sel-Sel Hepar Sebelum dan Sesudah Pemberian Gansiklovir Pada Pasien Anak Hepatitis CMV di RSUP Dr. Sardjito

MILLENINDA PASCA Y, dr. Agung Triono, Sp.A(K) ; dr. Wahyu Damayanti, M.Sc., Sp.A(K)

2020 | Skripsi | S1 KEDOKTERAN

Latar Belakang : Mayoritas infeksi CMV tidak menunjukkan gejala, namun 10% di antaranya dapat menimbulkan manifestasi, antara lain hepatitis. Hepatitis CMV sering dihubungkan dengan adanya kolestasis pada awal periode infan, serta dapat berakibat pada terjadinya sirosis serta kematian. Literatur medis dan studi mengenai keterlibatan hepatik dan keberhasilan terapi gansiklovir dalam memperbaiki nilai laboratorium fungsi hepar pasien masih belum banyak ditemukan. Tujuan : Mengetahui gambaran klinis kelainan hepar dan perbandingan nilai laboratorium fungsi serta penanda kerusakan sel-sel hepar sebelum dan sesudah pemberian gansiklovir pada pasien anak hepatitis CMV di RSUP Dr. Sardjito. Metode : Penelitian ini menggunakan rancangan studi kohort retrospektif pada 33 pasien anak yang mengalami hepatitis CMV di RSUP dr. Sardjito tahun 2014-2018. Seluruh pasien mengalami kolestasis yang ditegakkan berdasarkan pemeriksaan klinis dan penunjang yang tercatat pada rekam medis. Dilakukan pengambilan data gambaran klinis, nilai laboratorium darah (hemoglobin, trombosit, leukosit, neutrofil) dan penegakkan diagnosis CMV, nilai laboratorium fungsi hepar (PT, APTT, albumin, bilirubin total dan direk) dan penanda kerusakan sel-sel hepar (SGPT, SGOT, ALP, GGT) saat diagnosis yang akan dianalisis dengan statistik deskriptif. Data nilai laboratorium fungsi hepar dan penanda kerusakan sel-sel hepar saat diagnosis akan dibandingkan dengan data pada 1, 3, dan 6 bulan (±15 hari) sejak terapi gansiklovir dimulai dan akan dilakukan analisis perbedaan dengan uji t-paired atau uji Wilcoxon. Hasil : Gambaran klinis yang dialami subyek penelitian adalah jaundis 33 pasien (100%), hepatomegali 28 pasien (84,8%), urin berwarna seperti air teh 28 pasien (84,8%), feses berwarna seperti dempul 27 pasien (81,8%), dan splenomegali pada 18 pasien (54,5%), serta 6 (18,2%) subyek yang diketahui mengalami perburukan menjadi sirosis. Dari hasil analisis uji komparasi, didapatkan PT, albumin, bilirubin total, bilirubin direk, SGOT, dan ALP pada 1 bulan pasca terapi memiliki nilai p<0,05. Terdapat beberapa pasien yang tidak melakukan follow-up pada 3 dan 6 bulan pasca terapi. Kesimpulan : Ditemukan perbedaan yang signifikan secara statistik terhadap nilai PT, albumin, bilirubin total, bilirubin direk, SGOT, dan ALP subyek penelitian pada 1 bulan pasca pemberian gansiklovir.

Background : The majority of CMV infections are often asymptomatic, but 10% of them can cause manifestations, including hepatitis. CMV Hepatitis is often associated with cholestasis in the early infant period, and can result in cirrhosis or even death. Medical literature and studies regarding hepatic involvement and the effect of ganciclovir therapy in improving the laboratory value of patients' liver function have rarely been found. Objective : To determine the hepatic clinical manifestation and to compare the laboratory values of liver function and markers for liver cell damage, before and after the administration of ganciclovir to pediatric patients with CMV hepatitis at RSUP Dr. Sardjito. Method : A retrospective study was conducted using secondary data from 33 pediatric patients' medical record who had CMV hepatitis at RSUP dr. Sardjito in the year of 2014-2018. All patients experienced cholestasis which were diagnosed based on the clinical and supporting examination recorded in the medical record. Data of the clinical features, blood laboratory (hemoglobin, thrombocyte, leukocyte, and neutrophile), liver function test (PT, APTT, albumin, total and direct bilirubin), and markers of liver cell damage (AST, ALT, ALP, GGT) at the time of diagnosis were collected then be analyzed with descriptive statistics analysis. Data of the blood laboratory results, liver function values, and the markers of liver cell damage at the time of diagnosis were compared with the data at 1, 3, and 6 months (± 15 days) after ganciclovir therapy and were analyzed by t-paired test or Wilcoxon test. Result : Clinical features experienced by the subjects were jaundice in 33 patients (100%), hepatomegaly in 28 patients (84.8%), dark urine in 28 patients (84.8%), pale stool in 27 patients (81.8%), splenomegaly in 18 patients (54.5%), and also 6 (18.2%) subjects were developed into cirrhosis. From the results of the comparative test analysis, it was found that PT, albumin, total bilirubin, direct bilirubin, SGOT, and ALP of the patients at 1 month after therapy had a p value of <0.05. There are many patients who are loss of follow up at 3 and 6 months post-therapy. Conclusion : There are statistically significant differences on the value of PT, albumin, total bilirubin, direct bilirubin, SGOT, and ALP of the subjects at 1 month after administration of ganciclovir.

Kata Kunci : Cytomegalovirus, hepatitis, gansiklovir, gambaran klinis, nilai laboratorium hepar