Hasil guna L-ornitin L-aspartat intravena dibanding plasebo terhadap penurunan kadar amonia darah pada penderita ensefalopati hati

SYAHRIZAL, Prof. dr. Hj. Siti Nurdjanah, M.Kes., SpPD-KGEH

2010 | Tesis | S2 PPDS 1-Ilmu Penyakit Dalam

Pasien dengan penyakit hati kronik sering mengalami masalah neurologis dan yang paling sering dijumpai adalah ensefalopati hati (EH). Peningkatan kadar amonia darah diduga menjadi penyebab utama terjadinya EH. Amonia bekerja sebagai inhibitor neurotransmisi pada reseptor gamma-amino butyric acid (GABA) di sistem saraf pusat. L-Ornitin-L-Aspartat (LOLA) merupakan bentuk garam asam amino ornitin dan asam aspartat yang dapat menurunkan kadar amonia darah dengan cara merangsang siklus urea dan sintesis glutamin yang berperan penting dalam mekanisme detoksifikasi amonia. Penelitian ini menggunakan desain uji klinis acak buta ganda dan pemberian LOLA intravena dilaksanakan dalam waktu tiga hari. Terdapat 50 pasien yang menjadi subyek penelitian, 25 pasien di kelompok L-ornitin L-aspartat dan 25 pasien di kelompok plasebo. Beda rerata kadar amonia kelompok LOLA sebelum dan sesudah terapi dengan kelompok plasebo sebelum dan sesudah terapi diuji kemaknaannya dengan uji t tidak berpasangan. Hasilnya beda rerata kadar amonia pada kedua kelompok didapatkan tidak berbeda bermakna ( p = 0,846, 95% Interval Kepercayaan [IK]-50,63 – 61,44). Simpulan penelitian ini tidak terdapat perbedaan penurunan kadar amonia darah (NH3) pada penderita srosis hepatis dengan ensefalopati hati yang diberi LOLA dan plasebo.

Patients with chronic hepatitis often develop neurologic problems, the most common of which is hepatic encephalopathy (HE). Increase in the blood ammonia level is assumed to be the primary cause of HE. Ammonia works as the neurotransmission inhibitor on gamma-amino butyric acid (GABA) receptor at central nervous system. L-Ornithine-L-Aspartate (LOLA) is a form of ornithine amino acid and aspartate acid that may reduce the level of blood ammonia by stimulating urea cycle and glutamine synthesis, which play crucial roles in ammonia detoxification mechanism. In the recent study, administration of intravenous LOLA is conducted within three days. 50 patients, 25 patients in L-Ornithine L-aspartate group and 25 patients in Placebo group, participated in the study. Mean difference of ammonia level in LOLA group before and after the therapy compared to those in placebo group before and after the therapy were tested for their significance with unpaired t-test. It was found that the mean difference in the ammonia level for both group was not significant (p = 0,846, 95% Confidence Interval (CI) -50,63 – 61,44). The study concludes that there is no significant difference in the reduction of blood ammonia level (NH3) among cirrhosis hepatic patients with hepatic encephalopathy who received LOLA and those of placebo-controlled group.

Kata Kunci : Ensefalopati hati,Ammonia,LOLA, Hepatic Encephalopathy, ammonia, LOLA