Pengaruh Pentoxifylline terhadap Fibroindeks Pada Penderita Hepatitis Kronis B Penelitian Uji Klinis di bagian / SMF Ilmu Penyakit dalam Fakultas Kedokteran USU/ RS H Adam Malik Medan

Abstract

Background: Chronic Hepatitis B can lead to liver fibrosis and eventually evolve to end-stage liver disease. Hepatic fibrosis is reversible, understanding the pathogenesis of fibrosis had opened the use of anti-fibrotic therapies. Recently non invasive marker is developed instead of biopsy as gold standard because there are many limitations of this biopsy. One of the non invasive marker is FibroIndex. Pentoxifylline is assumed as anti-fibrosis by inhibiting HSC proliferation and colllagen syntesis on invitro and invivo. Aim : To assess the reduction of FibroIndex on chronic hepatitis B patients after pentoxifylline administration. Method: The study is conducted with prospective clinical trial and pre-post test design. Chronic hepatitis B patients with FibroIndex > 1,25 were recruited and being evaluate the rate of liver fibrosis with FibroIndex before and after pentoxifylline administration with dose 3x400 mg for 4 weeks. Results: From 15 patients consist of 12 males and 3 females, after 4 weeks of pentoxifylline administration we found there were significant reduction on GOT (67.3±35.9vs 53.4 ± 19.8 p=0.029), GPT (79.2 ± 20.0 vs 67.9 ± 13.9, p=0.009), total billirubin (1.65 ± 1.7 vs 1.16 ± 0.71, p=0.004). There were no significant increases on Albumin (4.43 ± 0.81 vs 4.49 ± 0.57,p=0.656), platelet (170.7 ± 59.0 vs 173.7 ± 61.7,p=0.643). There were no significant reduction on gamma globulin (1.90 ± 0,31 vs 1,89 ± 0,32,p=0,851), FibroIndex (1.86 ± 0.46 vs 1.77 ± 0.46, p= 0.057). Conclusions : Monitoring of pentoxifylline administration for 4 weeks on chronic hepatitis B patients shows reduction of hepatic fibrosis based on FibroIndex although it is not statistically significant. Pentoxifylline can also reduce ALT, AST and Billirubin effectively.

Latar Belakang: Hepatitis kronis B berlanjut menjadi fibrosis hati dan akhirnya berkembang menjadi penyakit hati tahap akhir. Fibrosis hati adalah reversibel dan pemahaman patogenesis fibrosis telah membuka peluang penggunaan terapi anti fibrosis. Saat ini telah dikembangkan penanda hati non invasif disamping biopsi hati sebagai standar baku emas karena banyak keterbatasan biopsi ini. Salah satu penanda ini adalah FibroIndeks. Pentoxifylline diasumsikan sebagai anti-fibrosis dengan menghambat aktivasi HSC dan sintesa kolagen secara invitro dan invivo. Tujuan: Untuk mengetahui penurunan FibroIndeks pada penderita hepatitis kronis B setelah pemberian pentoxifylline. Metode : Penelitian dilakukan secara uji klinis prospektif dengan perlakuan ulang. Pasien hepatitis kronis B dengan FibroIndeks > 1,25 diikutsertakan dan dilakukan penilaian fibrosis hati dengan FibroIndeks sebelum dan sesudah pemberian pentoxifyllline dengan dosis 3x400 mg selama 4 minggu. Hasil : Dari 15 orang pasien yaitu 12 pria dan 3 wanita, setelah 4 minggu pemberian pentoxifylline didapati penurunan bermakna pada GOT (67.3±35.9 vs 53.4 ± 19.8 p=0.029), GPT (79.2 ± 20.0 vs 67.9 ± 13.9, p=0.009), billirubin total (1.65 ± 1.7 vs 1.16 ± 0.71, p=0.004). Peningkatan tidak bermakna pada Albumin (4.43 ± 0.81 vs 4.49 ± 0.57,p=0.656), trombosit (170.7 ± 59.0 vs 173.7 ± 61.7,p=0.643). Penurunan tidak bermakna pada gamma globulin (1.90 ± 0,31 vs 1,89 ± 0,32,p=0,851), FibroIndeks (1.86 ± 0.46 vs 1.77 ± 0.46, p= 0.057). Kesimpulan : Pemantauan terapi pentoxifyllline selama 4 minggu pada penderita hepatitis kronis B menunjukkan penurunan fibrosis hati berdasarkan FibroIndeks walau tidak bermakna secara statistik. Pentoxifylline dapat juga menurunkan GOT, GPT dan billirubin secara efektif.