KORELASI ANTARA FAKTOR VON-WILLEBRAND PLASMA DAN KADAR FIBRINOGEN PLASMA PADA PENDERITA SIROSIS HATI DI RSUP DR SARDJITO YOGYAKARTA

Joko Priyanto, dr. Neneng Ratnasari, SpPD-KGEH

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Sirosis hati adalah suatu keadaan patologis yang menggambarkan stadium akhir fibrosis hepatik yang berlangsung progresif yang ditandai dengan distorsi arsitektur hepar dan pembentukan nodul degeratif. Komplikasi sirosis yang sering berakibat fatal adalah perdarahan varises esophagus. Gangguan hemostasis pada siros is bersifat ko mplek, melibatkan banyak proses dan faktor yang berperan. Teori terakhir mengemukakan bahwa pada sirosis terjadi ketidakseimbangan antara aktivitas prohemostatik dan antihemostatik. Pada prohemostatik salah satunya terdapat peningkatan kadar faktor von Willebrand, sedangkan pada antihemostatik terdapat penurunan kadar fibrinogen plasma. Saat ini belum ada data yang menunjukkan korelasi antara kadar fibrinogen plasma dan kadar faktor von Willebrand pada penderita sirosis di Indonesia, terutama di Yogyakarta. Tujuan dari penelitian ini adalah untuk mengetahui korelasi antara kadar fibrinogen plasma dan kadar faktor von Willebrand pada penderita sirosis. Desain penelitian adalah potong lintang. Pengambilan sampel dilakukan secara consecutive sampling. Subyek penelitian ini adalah penderita sirosis hati yang berkunjung ke Poliklinik Penyakit Dalam atau dirawat di Bagian Penyakit Dalam RS. Dr. Sardjito pada Oktober 2010 hingga Agustus 2011 yang memenuhi kriteria inklusi dan eksklusi. Korelasi antara kadar fibrinogen plasma dan kadar faktor von Willebrand dinilai secara statistik dengan uji korelasi. Hasil akhir uji korelasi dinyatakan dalam koefisien korelasi (r). Didapatkan 16 subyek yang memenuhi kriteria, 16 laki-laki da n 3 perempuan, rerata usia adalah 55±7,528. Penyebab sirosis 31,25% adalah infeksi virus hepatitis. Sebanyak 62,5% subyek adalah penderita sirosis Child-Pugh B dan sisanya Child-Pugh C. Rerata kadar fibrinogen plasma adalah 227,39±75,82 mg/dL, sedangkan rerata faktor von-Willebrand adalah 217,43±16,96 %. Koefisien korelasi Pearson’s antara kadar fibrinogen dan faktor von-Willebrand adalah r = -0,216 (p = 0,211). Kesimpulan terdapat korelasi negatif antara kadar fibrino gen dan faktor von-Willebrand pada pasien sirosis hati.

Liver cirrhosis is a pathological condition describing the end stadium of hephatitic phybrosis that continues progressively marked by the distortion of hepatic architecture and the formulation of degerenative nodules. Complication of cirrhosis that oftenly had fatal effects was the esophageal varices bleeding. The hemostatic disorders to the cirrhosis were complex, involving many processes and participated factors. The last theory suggested that in the cirrhosis, it found disequilibrium between the prohemostatic and antihemostatic. In the prohemostatic, one of them had an increase of the level of von-Willebrand factor, whereas in the antihemostatic there was a decrease of plasmatic fibrinogen level. Currently, there was not any data showed the correlation between the level of plasmatic fibrino gen and von-Willebrand factor in the patients of cirrhosis in Indonesia, especially in Yogyakarta. This study aimed to find the correlation between the level of plasmatic fibrinogen and von-Willebrand factor in the patients with cirrhosis. The design of this study was cross-sectional design. Samples were obtained by the consecutive sampling. Subjects of the study were the patients of liver cirrhosis who visited as outpatient and inpatient in the Department of Internal Medication of Dr. Sardjito Hospital from October 2010 to August 2011, and who already met the inclusion and exclusion criterias. The correlation between the level of plasmatic fibrino gen and von-Willebrand factor was assessed statisticly using correlation test. The final result of correlation test was stated in the correlation coefficient. There were 16 subjects that met criterias, 16 males and 3 females, age average was 55±7,528. Cause of cirrhosis 31,25% was viral hepatitis infection. As much 62,5% subject was Child Pugh's B and 37,5% was Child Pugh's C. Mean of plasma fibrinogen was 227,39±75,82 mg / dL, meanwhile von Willebrand's factor mean was 217,43±16,96 %. Pearson's correlation coefficients between fibrinogen and von Willebrand factor was r = 0,216 (p = 0,211). In conclusion, there was negative correlation between plasma fibrino gen and von Willebrand's factor in liver cirrhosis patients.

Kata Kunci : fibrinogen, faktor von Willebrand, sirosis hati