THE INCIDENCE AND SEVERITY OF LIVER TRANSAMINASE ELEVATION IN PULMONARY TUBERCULOSIS PATIENTS AFTER TWO MONTHS OF RHZE ANTI-TB TREATMENT IN INDONESIA

WAQQAS HANAFI, Dr. Jarir At Thobari, M.D., D.Pharm., Ph.D.; Dr. Trisasi Lestari, M.D., M.Med.Sc.

2015 | Skripsi | PENDIDIKAN DOKTER

Latar belakang Tuberkulosis (TB) adalah penyakit menular yang membunuh 1,1 juta orang per tahun. Terapi obat TB, RHZE, telah diketahui menyebabkan kerusakan hati akibat obat (DILI). DILI dapat dideteksi dengan elevasi transaminase hati dalam serum. Tujuan Untuk menentukan kejadian dan keparahan peningkatan kadar transaminase hati pada pasien TB setelah dua bulan pengobatan anti-TB RHZE. Metode Sebuah studi kasus kohort di mana ketinggian hati transaminase ALT dan AST diukur setelah terpapar terapi 2RHZE. Penelitian ini melibatkan 262 pasien TB Lampung dan Yogyakarta sebagai subyek. Hasil 2.18% dari subyek yang dikembangkan DILI sesuai dengan kriteria ATS. 15% dari subyek mengembangkan kelas yang lebih tinggi dari elevasi transaminase hati setelah dua bulan pengobatan RHZE. Sebanyak 20 (8%) subyek mengembangkan kelas yang lebih tinggi dari ALT elevasi dan 26 (12%) mengembangkan kelas yang lebih tinggi dari elevasi AST setelah dua bulan pengobatan dari sebelumnya. Kesimpulan Pasien yang menjalani terapi anti-TB RHZE mengalami elevasi transaminase yang cukup.

Background Tuberculosis (TB) is an infectious disease that kills 1.1 million people a year. TB’s drug therapy, RHZE, has been known to cause drug-induced liver injury (DILI). DILI can be detected by the elevation of liver transaminases in the serum. Objective To determine the incidence and severity of increases in liver transaminase levels in tuberculosis patients after two months of RHZE anti-TB treatment. Method A case cohort study where elevation of liver transaminases ALT and AST were measured after exposure to 2RHZE therapy. The study included 262 TB patients Lampung and Yogyakarta as subjects. Result 2.18% of the subjects developed DILI according to ATS criteria. 15% of the subjects developed a higher grade of liver transaminase elevation after two months of RHZE treatment. A total of 20 (8%) subjects developed a higher grade of ALT elevation and 26 (12%) developed a higher grade of AST elevation after two months of treatment than they had before. Conclusion Patients undergoing anti-TB RHZE therapy experienced considerable transaminase elevation.

Kata Kunci : Indonesia, liver enzymes, transaminase elevation, AST, ALT, DILI, hepatotoxicity, tuberculosis, first-line anti-TB, RHZE, isoniazid, rifampicin.