KORELASI ANTARA KADAR TUMOR NECROSIS FACTOR - α DAN PROFIL TROMBOSIT PADA PENDERITA SIROSIS HATI

NUR RACHMANI INDRAWATI, Dr. Neneng Ratnasari., SpPD-KGEH.

2013 | Tesis | S2 Ilmu Penyakit Dalam

Latar Belakang. Tumor necrosis factor-α merupakan sitokin utama yang terlibat dalam berbagai bentuk perlukaan hati. Kadar TNF-α meningkat pada sirosis hati dan diduga berkaitan dengan komplikasi sehubungan sirosis hati. Tumor necrosis factor dapat menyebabkan trombositopenia dengan menurunkan lifespan trombosit. Penurunan nilai trombosit pada sirosis dapat merupakan akibat rendahnya produksi trombosit, peningkatan sekuestrasi limpa/konsumsi trombosit, penurunan survival trombosit dan pengaruh trombopoetin yang rendah pada sirosis hati. Penurunan nilai MPV dapat dijumpai pada sirosis hati yang disertai trombositopenia. Nilai PDW meningkat pada sirosis hati. Derajat trombositopenia meningkat dengan penambahan keparahan fibrosis. Tujuan. Penelitian ini bertujuan untuk mengetahui apakah terdapat korelasi antara kadar TNF-α dengan profil trombosit pada penderita sirosis hati. Metode. Penelitian ini menggunakan rancangan studi potong lintang. Penelitian dimulai November 2010 sampai November 2011 (jumlah sampel terpenuhi). Subyek penelitian adalah pasien sirosis hati pada populasi terjangkau yang menjalani rawat jalan di poli Gastroentero-hepatologi atau rawat inap di bangsal Penyakit Dalam RSUP Dr Sarjito yang memenuhi kriteria inklusi dan eksklusi. Pemeriksaan darah vena dilakukan untuk mengukur kadar TNF-α dan profil trombosit yaitu angka trombosit (AT), mean platelet volume (MPV), dan platelet distribution width (PDW). Data disajikan dalam bentuk analisis deskriptif tentang karakteristik subjek penelitian berupa rerata dan simpangan baku kadar TNF-α dan profil trombosit. Korelasi antara kadar TNF-α dengan profil trombosit dinilai dengan analisis nonparametrik Spearman. Angka kemaknaan adalah p< 0.05. Hasil. Terdapat 36 subjek penelitian. Rerata kadar TNF-α 28,3 pg/ml (19,4-90,4), angka trombosit 93 ribu/mmk (40-307), MPV 10,5 fL (6,80-13,50), PDW 16,01±2,21 %. Tidak terdapat korelasi yang bermakna secara statistik antara kadar TNF-α dengan profil trombosit yaitu angka trombosit (r= -0,180; p= 0,295), nilai MPV (r= -0,253; p = 0,137) dan PDW (r= 0,05; p= 0,979) pada penderita sirosis hati. Kesimpulan. Penelitian ini menunjukkan tidak terdapat korelasi yang bermakna secara statistik antara kadar TNF-α dengan profil trombosit yaitu angka trombosit, MPV dan PDW pada penderita sirosis hati.

Background. Tumor necrosis factor-α is a major cytokine involved in various forms of liver injury. TNF-α levels increased in liver cirrhosis and allegedly associated with liver cirrhosis related complications. Tumor necrosis factor can cause thrombocytopenia by reducing platelet lifespan. Platelet impairment in cirrhosis may be due to low production of platelets, increased splenic sequestration / platelet consumption, decreased platelet survival and low thrombopoetin level in liver cirrhosis. Low mean platelet volume (MPV) can be found in liver cirrhosis with thrombocytopenia. Platelet distribution width (PDW) values increased in liver cirrhosis. The degree of severity of thrombocytopenia increased with the addition of fibrosis. Purpose. This study is aimed to determine whether there was correlation between the levels of TNF-α and platelet profile in liver cirrhosis patients. Method. This study was cross-sectional study design. Research began in November 2010 until November 2011 (total sample met). Subjects were patients with liver cirrhosis who visited to the Gastroentero-hepatology clinic or treated in the department of Internal Medicine ward Dr Sarjito Hospital, who meet the inclusion and exclusion criteria. Venous blood tests done to measure the levels of TNF-α and platelet profiles including platelet numbers (AT), mean platelet volume (MPV), and platelet distribution width (PDW). We analized correlation between the levels of TNF-α and platelet profiles using Spearman nonparametric analysis for data not normally distributed. Level of significance was P <0.05. Results. There were 36 research subjects. The mean levels of TNF-α were 28.3 pg / ml (19.4 to 90.4), mean of platelet numbers were 93 thousand / mmk (40-307), mean of MPV values were 10.5 fL (6.80 to 13.50), mean of PDW values were 16,01 ± 2.21%. There was no statistically significant correlation between the levels of TNF-α with the number of platelets (r = -0.180, p = 0.295), the value of MPV (r = -0.253, p = 0.137) and the value of PDW (r = 0.05; p = 0.979) in patients with liver cirrhosis. Conclusion. This study showed there were no statistically significant correlation between the levels of TNF-α with the platelet profile including numbers of platelets, MPV values and PDW values in patients with liver cirrhosis

Kata Kunci : TNF-α, profil trombosit, sirosis hati