PERBEDAAN KADAR FIBRINOGEN PLASMA PADA PENDERITA SIROSIS HATI BERDASARKAN KATEGORI FIBROSIS MENGGUNAKAN SKOR FIB-4

dr. Heppy Oktavianto, dr. Neneng Ratnasari, SpPD-KGEH,

2012 | Tesis | S2 Kedokteran Klinik

Penyakit sirosis hati merupakan kelanjutan fibrosis hati yang progresif sebagai respon dari injuri hati yang kronik, dan proses tersebut berakhir dengan sirosis hati dimana terjadi hipertensi portal dan kegagalan fungsi hati. Pada sirosis hati terjadi gangguan sintesis faktor pembekuan dan antikoagulan, dimana sebagian besar faktor pembekuan diproduksi di dalam hati, termasuk fibrinogen. Metodemetode noninvasif telah dikembangkan untuk menilai fibrosis hati dan salah satu tes diagnosis noninvasif untuk menilai fibrosis hati yang sederhana, tersedia, ekonomis, dan akurat adalah skor FIB-4. Penelitian ini bertujuan untuk mengetahui perbedaan kadar fibrinogen plasma pada penderita sirosis hati berdasarkan kategori fibrosis dengan menggunakan skor FIB-4. Metode penelitian yang digunakan pada penelitian ini adalah cross sectional (studi potong lintang). Penelitian dilakukan di Poliklinik Gastroentero-Hepatologi dan Bangsal Penyakit Dalam RSUP Dr.Sardjito Yogyakarta mulai Januari 2011 sampai Desember 2011. Kriteria inklusi adalah penderita terdiagnosis sirosis hati berdasarkan kriteria klinis, laboratoris, dan USG hati, penderita usia dewasa (≥18 tahun), dan menandatangani persetujuan penelitian. Kriteria eksklusi adalah jika mengalami sepsis, jejas jaringan, kanker lain dan gangguan imunologis. Hasil penelitian didapatkan subyek penelitian yang memenuhi kriteria inklusi sebanyak 40 orang, 25 pria (62,5%) dan 15 wanita (37,5%). Rata-rata kadar fibrinogen pada penelitian ini adalah 183,35 (28-629) mg/dL. 4 subyek (10%) masuk kategori FIB-4 <1,45; 11 subyek (27,5%) kategori 1,45-3,25; dan 25 subyek (62,5%) masuk kategori >3,25; dengan uji Kruskall-Wallis didapatkan nilai p=0,012. Dengan analisis Post Hoc menggunakan uji Mann-Whitney perbedaan fibrinogen antara kategori I&II didapatkan nilai p=0,360; kategori I&III didapatkan nilai p=0,043; dan kategori II&III didapatkan nilai p=0,012. Kesimpulan penelitian ini menunjukkan terdapat perbedaan kadar fibrinogen plasma yang bermakna secara statistik pada pasien sirosis hati berdasarkan kategori fibrosis menggunakan skor FIB-4.

Cirrhosis of the liver disease was a continuation of progressive liver fibrosis in response to chronic liver injury, and the process ended with cirrhosis of the liver and portal hypertension where there was liver failure. In cirrhosis of the liver, there were disturbances of synthesis of clotting factors and anticoagulation, where most of the clotting factors were produced in the liver, including fibrinogen. Noninvasive methods have been developed to assess liver fibrosis and one of noninvasive diagnostic tests to assess liver fibrosis was FIB-4 score there was simple, available, economical, and accurate. This study aimed to determine differences in plasma fibrinogen levels in patients with cirrhosis of the liver by fibrosis category using FIB4 score. The research method used in this study was cross-sectional study. The study was conducted at The Clinic of Gastroentero-Hepatology and Internal Medicine Ward Dr.Sardjito Hospital Yogyakarta from January 2011 until December 2011. Inclusion criteria were patients with cirrhosis of the liver, diagnosed based on clinical criteria, laboratory, and ultrasound liver, adult patients (≥ 18 years), and signed a research agreement. The exclusion criteria were if having sepsis, other cancers, and immunological disorders. The result showed that the subjects of the study who met the inclusion criteria were 40 people, 25 men (62.5%) and 15 women (37.5%). Average fibrinogen levels in this study were 183.35 (28-629) mg / dL. 4 subjects (10%) in the category of FIB4 <1.45; 11 subjects (27.5%) in category from 1.45 to 3.25, and 25 subjects (62.5%) in the category of> 3.25; with Kruskall-Wallis test obtained p = 0.012. By Post Hoc analysis using the Mann-Whitney test, fibrinogen difference between category I and II obtained p-value = 0.360; category I & III obtained p = 0.043, and category II & III obtained p = 0.012. Conclusion of this study showed that differences in plasma fibrinogen levels were statistically significant in patients with cirrhosis of the liver by fibrosis category using FIB-4 score.

Kata Kunci : fibrinogen, fibrosis, skor FIB-4, sirosis hati