Kadar seng serum dan kadar amonia darah penderita sirosis hati berdasarkan skor child-turcotte-pugh

TRIWIKATMANI, Catharina, Prof. dr. Siti Nurdjanah, M.Kes., SpPD-KGEH

2008 | Tesis | S2 PPDS I - Ilmu Penyakit Dalam

Pendahuluan. Keparahan sirosis hati dapat dinilai dengan sistem skoring Child- Turcotte-Pugh (CTP). Semakin tinggi skor, semakin berat keparahan penyakit hati. Seng adalah trace element penting bagi tubuh yang terlibat pada berbagai peran fisiologis, sedangkan amonia adalah neurotoksin kunci dalam patogenesis ensefalopati hati. Pada sirosis hati fungsi hati terganggu dan terjadi pintas darah di sekitar hati sehingga amonia dalam darah meningkat. Defisiensi seng dan peningkatan kadar amonia umum terjadi pada pasien sirosis hati. Tujuan penelitian ini adalah untuk mengetahui perbedaan rerata kadar seng serum dan kadar amonia darah pada penderita sirosis hati menurut skor CTP. Metode dan subyek. Desain penelitian adalah potong lintang. Penelitian ini dilakukan pada pasien sirosis hati dewasa yang berkunjung ke Poliklinik Penyakit Dalam atau dirawat inap di Bangsal Perawatan Penyakit Dalam RSUP Dr. Sardjito Yogyakarta. Sampel darah diambil pagi hari setelah pasien berpuasa sekurangnya selama 8 jam. Kadar seng serum diukur menggunakan metode flame atomic absorption spectrophotometry (AAS) sedangkan kadar amonia darah diukur menggunakan metode mikrodifusi. Dilakukan uji Mann-Whitney U untuk mengetahui perbedaan rerata kadar seng serum dan kadar amonia darah antara kelompok skor CTP B dan kelompok skor CTP C. Batas kemaknaan adalah p < 0,05. Hasil. Didapatkan 36 pasien yang memenuhi kriteria penelitian selama periode 1 Mei – 30 September 2007. Pengelompokkan menurut skor CTP mendapatkan pasien dengan skor A, B, dan C, berturut-turut adalah 2, 24, dan 10 pasien. Pasien dengan skor CTP A tidak dianalisis. Dari 34 pasien tersebut terdapat 25 (74%) pasien lakilaki dan 9 (26%) pasien perempuan. Rerata usia pasien adalah 55,59 ± 13,30 tahun dengan nilai median 57 (29-80) tahun. Terdapat penyakit penyerta DM pada 7 pasien (20,59%). Lama diketahui menderita sirosis hati terbanyak kurang dari 5 tahun (27 pasien, 79,41%). Rerata kadar seng serum adalah 63,67 ± 25,44 (simbol)g/dL dengan median 59,08 (23,25-119,36) (simbol)g/dL. Pasien dengan hypozincemia sebanyak 23 pasien (67,65%). Rerata kadar amonia adalah 170,15 ± 74,83 N-(simbol)g/dL dengan median 166 (66-400) N-(simbol)g/dL. Kadar amonia (simbol) 75 N-(simbol)g/dL didapatkan pada 33 pasien (97,06%). Hasil kemaknaan uji perbedaan rerata kadar seng serum antara skor CTP B (67,68 ± 21,55 (simbol)g/dL) dengan skor CTP C (54,04 ± 32,25 (simbol)g/dL) adalah p = 0,05, sedangkan rerata kadar amonia darah antara skor CTP B (162,58 ± 70,07 N-(simbol)g/dL) dengan skor CTP C (188,30 ± 86,41 N-(simbol)g/dL) adalah p = 0,395, yang menunjukkan keduanya tidak terdapat perbedaan yang bermakna secara statistik. Simpulan. Tidak ditemukan perbedaan kadar seng serum puasa dan kadar amonia darah puasa pada penderita sirosis hati antara skor CTP B dengan skor CTP C.

Introduction. The severity of liver cirrhosis can be measured by the Child-Turcotte- Pugh (CTP) scoring system. Higher score means more severe of liver disease. Zinc is an important trace element for our body and it is involved in a wide variety of physiologic roles, while ammonia is the most important neurotoxin thought to be involved in the pathophysiology of hepatic encephalopathy. Zinc deficiency and increased ammonia level are common in liver cirrhotic patients. The objective of the study is to know mean differences of serum zinc and of blood ammonia concentration according to the CTP score. Methods and subjects. The study design was cross-sectional. It was conducted in adult patients who attended outpatient clinic or hospitalized in the Internal Wards of Dr. Sardjito Hospital Yogyakarta. Blood samples were collected after patients had fasted for at least 8 hours. Sera zinc levels were measured by the flame atomic absorption spectrophotometry (AAS) method, while blood ammonia levels were measured by the microdiffusion method. Mann-Whitney U test was performed to measure mean differences of zinc and of ammonia concentration between CTP score B and C, with level of significance was less than 5 percent. Results. Thirty six patients were eligible for this study between May 1st and September 30th 2007, 2 patients were in CTP class A, 24 patients were in class B, and 10 patients were in class C. The patients in CTP class A were not analyzed. Of the 34 patients, there were 25 (74%) male patients and 9 (26%) female patients. Mean of age was 55.59 ± 13.30 with median 57 (29-80) years old. There were DM in 7 patients (20.59%). Duration of cirrhosis were less than 5 years in 27 patients (79.41%). Mean of sera zinc levels was 63.67 ± 25.44 (symbol)g/dL with median 59.08 (23.25-119.36) (symbol)g/dL. Patients with hypozincemia were 23 patients (67.65%). Mean of ammonia levels was 170.15 ± 74.83 N-(symbol)g/dL with median 166 (66-400) N-(symbol)g/dL. Ammonia levels of (symbol) 75 N-(symbol)g/dL were found in 33 patients (97.06%). Significancy result of mean difference test of serum zinc between CTP score B (67.68 ± 21.55 (symbol)g/dL) and CTP score C (54.04 ± 32.,25 (symbol)g/dL) was p = 0.052, while of blood ammonia levels between CTP score B (162.58 ± 70.07 N-(symbol)g/dL) and CTP score C (188.30 ± 86.41 N- (symbol)g/dL) was p = 0.395. Both showed no statistical significancies. Conclusion. There were no differences of fasting serum zinc and of fasting blood ammonia concentrations in cirrhotic patients between the Child-Turcotte-Pugh scores B and C.

Kata Kunci : Seng,Amonia,Sirosis hati, zinc, ammonia, liver cirrhosis