KORELASI ANTARA ASAM HYALURONAT DENGAN SKOR FIB-4 PADA PENDERITA HEPATITIS KRONIK DAN SIROSIS HATI

Mohammad Septa Adiwanda Saputra, dr. Neneng Ratnasari, Sp.PD-KGEH

2014 | Tesis | S2 Ked.Klinik/MS-PPDS

Sirosis hati merupakan perjalanan patologi akhir berbagai macam penyakit hati. World Health Organization (WHO) memberi batasan histologi sirosis sebagai proses kelainan hati yang difus, ditandai fibrosis dan perubahan bentuk hati yang normal ke bentuk nodul-nodul yang abnormal. Saat ini telah dikembangkan penilaian fibrosis hati yang bersifat non invasif berdasarkan pemeriksaan laboratorium rutin dan laboratorium khusus yaitu pemeriksaan berdasarkan skor FIB-4 dan pemeriksaan kadar asam hyaluronat plasma. Banyak berbagai penelitian sebelumnya yang menyimpulkan bahwa kedua pemeriksaan tersebut terbukti dapat menilai derajat keparahan fibrosis. Selama ini belum pernah ada penelitian yang menghubungkan antara skor FIB-4 dengan pemeriksaan kadar asam hyaluronat plasma. Penelitian ini dilakukan untuk mengetahui adanya korelasi antara kadar asam hyaluronat plasma dengan penilaian fibrosis menurut skor FIB-4 pada penderita hepatitis kronik dan sirosis hati. Metode penelitian yang digunakan pada penelitian ini yaitu potong lintang. Penelitian dilakukan di poliklinik Gastroenterohepatologi dan Bangsal Penyakit Dalam RSUP Dr. Sardjito Yogyakarta. Kriteria inklusi adalah pasien dengan diagnosis hepatitis kronik dan sirosis hati berdasarkan kriteria klinis, laboratorium dan USG hati, pasien usia > 18 tahun, bersedia mengikuti penelitian dan mendatangani persetujuan. Kriteria eksklusi adalah adanya osteoartritis, rheumatoid arthritis, diabetes melitus, tumor ganas, psoriasis, sklerosis dan sepsis. Rerata kadar asam hyaluronat plasma penderita hepatitis kronik adalah 176 ± 10,27 μg/L dan skor FIB-4 1,8 ± 1,61 sedangkan pada penderita sirosis hati didapatkan rerata kadar asam hyaluronat plasma adalah 256 ± 18,84 μg/L dan skor FIB-4 adalah 5,7 ± 4,04. Pada kelompok hepatitis kronik, tidak terdapat korelasi antara asam hyaluronat dengan skor FIB-4 (r=0,005; p=0,985). Pada kelompok sirosis hati, terdapat korelasi antara asam hyaluronat dengan skor FIB-4 (r=0,170; p=0,328). Pada sub.analisis, korelasi antara asam hyaluronat dengan skor FIB-4 kelompok severe fibrosis dengan sirosis hati didapatkan korelasi positif (r=0,55; p=0,001). Kesimpulan penelitian ini terdapat korelasi antara kadar asam hyaluronat dengan penilaian fibrosis menurut skor FIB-4 pada sirosis hati dan kelompok sub.analisis.

Cirrhosis of the liver is a journey final pathology of various diseases liver. World Health Organization ( WHO ) provides limits histology liver cirrhosis as the diffuse abnormality, marked fibrosis and normal liver changes shape to form abnormal nodules. Currently has developed assessment of liver fibrosis by non invasive examination and routine laboratory specialized laboratory that is based on examination scores and examination FIB - 4 plasma levels of hyaluronic acid. Many previous studies which concluded that a second examination proved to be able to assess the severity of fibrosis. So far there have not been studies linking between FIB- 4 with an examination of plasma levels of hyaluronic acid . This study was conducted to determine the correlation between plasma levels of hyaluronic acid with fibrosis assessment by FIB - 4 in patients with chronic hepatitis and liver cirrhosis. The method used in this study is cross-sectional. The study was conducted in the clinic and ward gastroenterohepatologi Medicine Hospital Dr . Sardjito. Inclusion criteria were patients with a diagnosis of chronic hepatitis and liver cirrhosis based on clinical criteria, laboratory and liver ultrasound, patients aged > 18 years, following the research and willing to approach approval. Exclusion criteria were the presence of osteoarthritis, rheumatoid arthritis, diabetes mellitus, malignancy, psoriasis, multiple sclerosis and sepsis. The mean plasma hyaluronic acid levels of patients with chronic hepatitis were 176 ± 10,27 μg / L and FIB-4 score of 1,8±1,61 whereas in patients with liver cirrhosis obtained mean plasma hyaluronic acid levels were 256 ± 18,84 μg / L and FIB-4 score was 5,7 ± 4,04. In the group of chronic hepatitis , there is no correlation between hyaluronic acid with FIB-4 score (r =0,005; p=0,985). In the liver cirrhosis group , there is correlation between hyaluronic acid with FIB-4 score (r = 0,170; p=0,328). In sub.analisis , the correlation between hyaluronic acid with FIB-4 score group advanced fibrosis with liver cirrhosis was positive correlation (r = 0,55; p = 0,001) . In conclusion, there is a correlation between the levels of hyaluronic acid with fibrosis assessment by FIB - 4 in patients with liver cirrhosis and sub.analisis group.

Kata Kunci : Hepatitis kronik, sirosis hati, asam hyaluronat, skor FIB-4