HUBUNGAN ANTARA DERAJAT KEPARAHAN SIROSIS HATI DENGAN DERAJAT DISFUNGSI EREKSI PADA PASIEN SIROSIS HATI

RACHMAD AJI SAKSANA, Prof. dr. Siti Nurdjanah, Sp.PD-KGEH, M.Kes.

2015 | Tesis | SP Ilmu Penyakit Dalam

Latar belakang : Sirosis hati menyebabkan semua fungsi hati terganggu, termasuk keseimbangan hormonal dan metabolisme steroid. Pada pria, sirosis hati menyebabkan terjadi hypogonadisme dan feminisasi. Gangguan fungsi seksual pada penderita sirosis hati masih underestimate dan underdiagnosis karena bukan merupakan komplikasi yang mengancam jiwa, sehingga pasien tidak mencari pertolongan namun gangguan tersebut berpengaruh terhadap kualitas hidup pasien dan pasangan hidupnya. Gangguan seksual yang sering dikeluhkan pria berupa impotensi atau disfungsi ereksi. Walaupun prevalensi disfungsi ereksi tinggi pada pasien sirosis hati namun masih sedikit penelitian yang mengungkap hubungan antara derajat sirosis hati dengan derajat disfungsi ereksi. Tujuan penelitian : mengetahui korelasi antara derajat keparahan sirosis hati (skor child pugh) dengan derajat disfungsi ereksi (skor International Index of Erectile Function 5 / IIEF- 5). Pasien dan metode : Desain penelitian adalah potong lintang. Subyek penelitaian adalah pasien sirosis hati yang bejenis kelamin laki-laki yang berobat di poliklinik gastroentero – hepatologi di bagian penyakit dalam RSUP dr Sardjito Yogyakarta selama bulan Oktober 2012 sampai dengan Oktober 2014. Semua subyek diminta menjawab questioner IIEF-5, untuk menilai derajat disfungsi ereksi. Pemeriksaan fisik dilakukan untuk menilai asites dan enchepalopaty hepatikum. Semua pasien menjalani pemeriksaan laboratorium kadar bilirubin, albumin, dan INR Derajat keparahan sirosis dinilai berdasarkan skor child pugh. Data dianalisis dengan mengunakan SPSS 16. Hasil : Terdapat 27 subyek yang sesuai dengan kriteria inklusi dan ekslusi, dengan usia rerata 49,56 ± 9,93 tahun. Duapuluh dua (81,5 %) subyek sirosis disebabkan infeksi viral, 15 (55,6%) hepatitis B, 7 (25,9%) hepatitis C dan 5 (18,5%) non B dan non C. Sirosis hati child A sebanyak 7 (25,9 %) subyek, child B 8 (29,6%) subyek dan child C 12 (44,4%), dengan rerata skor child pugh sebesar 8,85 ± 2,50. Disfungsi ereksi (DE) dialami sebanyak 22 (81,5 %), subyek DE berat 12 (44,4 %) subyek, DE sedang 6 (22,2 %) subyek dan DE ringan 4 (14,8%) subyek dengan rerata skor IIEF5 sebesar 14,44 ± 6,02. Analisis korelasi menunjukkan bahwa skor child pugh berkorelasi negatif kuat dengan skor IIEF-5 (r = -0,657; P= 0,000). Skor child pugh tetap berkorelasi dengan skor IIEF-5 setelah disesuaikan dengan variabel perancu (P= 0,020). Semua komponen child pugh berkorelasi dengan skor IIEF-5, kadar bilirubin (r = -0,572; P = 0,001), derajat ensefalopati (r = -0,520; P = 0,003), Kadar albumin (r = 0,504; P = 0,003), derajat asites (r = - 0,503; P = 0,004), INR (r = -0,410; P = 0,017). Simpulan : Terdapat korelasi kuat antara derajat keparahan sirosis dengan derajat keparahan disfungi ereksi.

Background: Liver cirrhosis caused all impaired liver function, including hormonal imbalance and steroid metabolism. Liver cirrhosis cause hypogonadism and feminization in male. Sexual dysfunction in patients liver cirrhosis was underdiagnose and underestimate because it was not a life-threatening complications, hence patients didn’t seek help, however, it affects the quality of life patients and his partner. Male sexual dysfunction often expressed as impotence or erectile dysfunction. Although prevalence of erectile dysfunction was high, few studies have been revealing relationship between liver cirrhosis severity with erectile dysfunction severity. Objectives: To determine the correlation between liver cirrhosis severity (child pugh score) with erectile dysfunction severity (IIEF-5 score) in cirrhosis patients. Patients and methods: The study design was cross-sectional. Subjects were male cirrhosis patients who went to Gastroentero-hepatology clinic of Dr Sardjito general hospital, yogyakarta, during October 2012 to October 2014. All subjects were asked to answer IIEF- 5 questionnaire, to assess erectile dysfunction severity. A physical examination was performed to assess liver ascites and enchepalopaty. Laboratory tests performed to measure bilirubin level, albumin level, and INR. Cirrhosis severity assessed according child Pugh score. Data were analyzed using SPSS 16. Results: There were 27 subjects who met inclusion and exclusion criteria, mean of age was 49.56 ± 9.93 years. Twenty-two (81.5%) subjects cirrhosis caused by viral infection, 15 (55.6%) hepatitis B, 7 (25.9%) hepatitis C, and 5 (18.5%) non-B and non-C. Cirrhosis Child A 7 (25.9%) subjects, child B 8 (29.6%) subjects and child C 12 (44.4%) subjects, mean child Pugh score 8.85 ± 2.50. Erectile dysfunction (ED) was found in 22 (81.5%) subjects, severe ED 12 (44.4%) subjects, moderate ED 6 (22.2%) subjects and mild ED 4 (14.8%) subjects, mean IIEF-5 score 14.44 ± 6.02. Statistic analysis showed that child pugh score was strongly negative correlated to IIEF-5 score (r = -0.657; P = 0.000). Pugh child score remain correlated with IIEF-5 scores after adjusted with confounding variables (P = 0.020). All child pugh components correlated with IIEF-5, bilirubin levels (r = -0.572; P = 0.001), encephalopathy (r = -0.520; P = 0.003), albumin (r = 0.504; P = 0.003), ascites (r = - 0.503; P = 0.004), INR (r = -0.410; P = 0.017). Conclusions: There was a strong correlation between liver cirrhosis severity with erectile dysfunction severity.

Kata Kunci : sirosis hati, skor child pugh, disfungsi ereksi, IIEF -5, korelasi