Hubungan Antara Angka Platelet (PLT), Plateletcrit (PCT), Dan Mean Platelet Volume (MPV) Dengan Tingkat Keparahan Kolitis Ulseratif Berdasarkan Kriteria Truelove Witts

SISCA WULANDARI, Dr. dr. Neneng Ratnasari, Sp.PD, KGEH.; dr. Fahmi Indrarti, Sp.PD, KGEH

2022 | Tesis-Spesialis | ILMU PENYAKIT DALAM

Latar Belakang: Pada kolitis ulseratif terjadi abnormalitas respon imun yang melibatkan platelet. Perubahan jumlah, ukuran, dan kepadatan platelet pada kolitis ulseratif mungkin merupakan indikator aktivitas penyakit, walaupun belum sepenuhnya dipahami. Tujuan Penelitian: Mengetahui hubungan antara angka platelet (PLT), plateletcrit (PCT), dan mean platelet volume (MPV) dengan tingkat keparahan kolitis ulseratif. Metode Penelitian: Penelitian ini merupakan studi retrospektif yang dilaksanakan menggunakan metode cross sectional dengan consecutive sampling dalam kurun waktu Juli 2020 - Juli 2021. Subjek penelitian adalah penderita kolitis ulseratif yang menjalani rawat inap atau rawat jalan di RSUP Dr. Sardjito yang memenuhi kriteria inklusi dan kriteria eksklusi. Angka platelet (PLT), plateletcrit (PCT), dan mean platelet volume (MPV) didapatkan dari laboratorium patologi klinik. Diagnosis kolitis ulseratif berdasarkan klinis, kolonoskopi, dan biopsi mukosa kolon. Penilaian keparahan penyakit kolitis ulseratif menggunakan kriteria Truelove Witts. Analisis menggunakan program komputer dengan nilai p<0,05 dan z>1,96 dianggap bermakna secara statistik. Hasil Penelitian: Terdapat 47 subyek penelitian dengan rata-rata usia 53,60 +- 11,79. Jumlah pasien laki-laki 26 orang (55,3%) dan perempuan 21 orang (44,7%). Tingkat keparahan kolitis ulseratif dibagi menjadi tiga kelompok dengan jumlah pasien colitis ulseratif ringan 21 orang (44,7 %), sedang 9 orang (19,1 %), dan berat 17 orang (36,2 %). Mean angka platelet pada kelompok tingkat keparahan ringan 243857,14/mcgL +- 65504,42, sedang 313555,56/mcgL +- 86830,45, dan berat 338470,58/mcgL +- 107343. Analisis menggunakan paired sample proportion test didapatkan hubungan antara angka platelet dengan tingkat keparahan kolitis ulseratif secara bermakna (p<0,001; z=-4,000). Median angka plateletcrit pada kelompok tingkat keparahan ringan 0,17% (0,13 - 0,31), sedang 0,18% (0,15 - 0,42), dan berat 0,21% (0,13 - 0,48). Median angka MPV pada kelompok tingkat keparahan ringan 7,40 fL (5,40 - 13,60), sedang 6,20 fL (4,60 - 10,20), dan berat 6,70 fL (4,30- 11,10). Analisis menggunakan related sample Wilcoxon signed rank test didapatkan hubungan bermakna antara angka plateletcrit dengan tingkat keparahan kolitis ulsertif (p<0,001;z=-5,968) dan angka MPV dengan tingkat keparahan kolitis ulseratif (p<0,001;z=5,969). Kesimpulan: Terdapat hubungan antara angka platelet, plateletcrit, dan mean platelet volume dengan tingkat keparahan kolitis ulseratif secara bermakna.

Background: In ulcerative colitis there is an abnormal immune response involving platelets. Changes in platelet count, size, and density in ulcerative colitis may be an indicator of disease activity, although they are not fully understood. Objectives: To determine the association between platelet count (PLT), plateletcrit (PCT), and mean platelet volume (MPV) with the severity of ulcerative colitis. Methods: This is a retrospective, cross sectional study with consecutive sampling in the period July 2020 - July 2021. The research subjects were ulcerative colitis inpatient or outpatient at Dr. Sardjito Hospital who met the inclusion and exclusion criteria. Platelet count (PLT), plateletcrit (PCT), and mean platelet volume (MPV) were obtained from the clinical pathology laboratory. Diagnosis of ulcerative colitis was based on clinical, colonoscopy and colonic mucosal biopsy. Ulcerative colitis severity was assessed using the Truelove Witts criteria. Analysis using a computer program with p<0.05 and z>1.96 was considered statistically significant. Result: There were 47 research subjects with a mean age of 53.60 +- 11.79. The number of male and female patients was 26 (55.3%) and 21 (44.7%), respectively. The severity of ulcerative colitis was divided into three groups with the number of patients with mild, moderate, dan severe ulcerative colitis were 21 (44.7%), 9 (19.1%), and 17 (36.2%), respectively. The mean platelet count in the mmcgL +- 65504.42, 313555.56/mcgL +- 86830.45, and 338470.58/mcgL +- 107343, respectively. Analysis using the paired sample proportion test found a significant association between platelet count and the severity of ulcerative colitis (p<0.001; z=-4.000). The median plateletcrit in the mild, moderate, and severe severity group was 0.17% (0.13 - 0.31), 0.18% (0.15- 0.42), and 0.21% (0.13 -0.48), respectively. The median MPV in the mild, moderate, and severity group was 7.40 fL (5.40 - 13.60), 6.20 fL (4.60 - 10.20), and 6.70 fL (4.30 - 11.10), respectively. Analysis using the related sample Wilcoxon signed rank test found a significant association between plateletcrit with the severity of ulcerative colitis (p<0.001;z=-5.968) and MPV with the severity of ulcerative colitis (p<0.001;z=5.969). Conclusion: Platelets count, plateletcrit, and mean platelet volume were significantly associated with the severity of ulcerative colitis.

Kata Kunci : kolitis ulseratif, platelet, plateletcrit, mean platelet volume, ulserative colitis, platelet, plateletcrit, mean platelet volume