Hubungan antara Ekspresi Leucocyte Cell-Derived Chemotaxin 2 (LECT2) terhadap Ekspresi Collagen Type 1 Alpha 1 (COL1A1) pada Pasien Atresia Bilier Pasca Operasi Kasai

Henggar Allest Pratama, dr. Andi Dwihantoro, Sp.B., Sp.BA., Subsp. D.A. (K).; Prof. dr. Gunadi, PhD., Sp.BA, Subsp. D.A. (K)

2024 | Tesis-Spesialis | S2 Ilmu Bedah Anak

Atresia bilier adalah sebuah kondisi medis terdapatnya obstruksi pada traktus biliaris. Tindakan Kasai merupakan prosedur bedah untuk mengalirkan bile (empedu) menuju ke intestinal. Meskipun sudah dilakukan prosedur Kasai namun sebagian kasus atresia bilier masih berkembang menjadi liver fibrosis. Salah satu gen yang yang diduga terlibat adalah LECT2. LECT2 mengatur aktivasi TGF-? yang kemudian mengatur ekspresi COL1A1. Peningkatan mRNA LECT2 bersama COL1A1 menghambat proliferasi dan meningkatkan aktivitas apoptosis sel stellata hati yang mengarah ke fibrosis hati. Penelitian ini dilakukan untuk mengetahui perbandingan ekspresi COL1A1 pada pasien atresia bilier pasca operasi Kasai dibandingkan dengan kelompok kontrol dan mengetahui hubungan antara ekspresi LECT2 dengan ekspresi COL1A1. Design penelitian cross sectional pada pasien pediatri yang terdiagnosis kolestasis yang dilakukan kolangiografi intraoperatif dan biopsi hepar, kemudian ekspresi COL1A1 dibandingkan antara kelompok atresia bilier dengan kelompok kontrol dan dilihat hubungan antara ekspresi LECT2 dengan ekspresi COL1A1. Hasilnya didapatkan 25 sampel hepar yang terdiri atas 12 (48%) atresia bilier dan 13 (52%) kontrol. Hasilnya didapatkan hubungan ekspresi COL1A1 yang bermakna pada pasien atresia bilier dan kontrol (p=0,002), derajat fibrosis (p=0,007), dan tipe atresia bilier (p=0,04). Didapatkan juga hubungan bermakna antara LECT2 terhadap COL1A1 (p=0,014) dengan korelasi positif (R2=0,223). Kesimpulannya, terdapat peningkatan ekspresi COL1A1 pada pasien atresia bilier dibandingkan dengan kontrol dan ekspresi LECT2 berhubungan signifikan dengan ekspresi COL1A1.

Biliary atresia is a medical condition where there is obstruction in the biliary tract. Kasai is a surgical procedure to drain bile to the intestine. Although the Kasai procedure has been performed, some cases of biliary atresia still develop into liver fibrosis. One of the genes suspected of being involved is LECT2. LECT2 regulates the activation of TGF-? then regulates the expression of COL1A1. Increased LECT2 mRNA together with COL1A1 inhibits proliferation and increases the apoptosis activity of hepatic stellate cells lead to liver fibrosis. This study try to determine the comparison of COL1A1 expression in biliary atresia patients after Kasai surgery compared to the control group and to determine the relationship between LECT2 expression and COL1A1 expression. This study was conducted cross-sectionally in pediatric patients diagnosed with cholestasis who underwent intraoperative cholangiography and liver biopsy, then COL1A1 expression was compared between the biliary atresia group and the control group and the relationship between LECT2 expression and COL1A1 expression. As the results, 25 liver samples were obtained consisting of 12 (48%) biliary atresia and 13 (52%) controls. The results showed a significant relationship between COL1A1 expression in biliary atresia patients and controls (p=0.002), degree of fibrosis (p=0.007), and type of biliary atresia (p=0.04). A significant relationship was also found between LECT2 and COL1A1 (p=0.014) with a positive correlation (R2=0.223). In conclusion, there is an increase in COL1A1 expression in biliary atresia patients compared to controls and LECT2 expression is significantly related to COL1A1 expression.

Kata Kunci : atresia bilier, fibrosis hepar, LECT2, COL1A1