Pengaruh Pentoxifylline terhadap Perubahan Skor Forns Penderita Hepatitis Kronis B

Abstract

Background: Chronic Hepatitis B can lead to liver fibrosis and eventually evolve to cirrhosis hepatis and the end-stage liver disease. Hepatic fibrosis is reversible, and understanding the patogenesis of fibrosis had opened the use of anti-fibrotic therapies. To date, there is no appropriate treatment for liver fibrosis and patients depend on liver transplantation. Thus, Anti-fibrotic farmachoterapy was needed. Pentoxifylline was postulated acted as anti-fibrosis by inhibiting HSC proliferation and colllagen sintesis on invitro and invivo. Aim : To know the decreasing of Forns Score for pateints with chronic hepatitis B after pentoxifylline administration. Method: Fourteen patients with chronic hepatitis B with the elevation of GPT (>1.3 times) was done clinically assessment of Forns score before and after pentoxifylline administration with dose 3x400 mg for 4 weeks. Results: After 4 weeks of therapy, There were significant decreases on GOT (65.1 ± 37.3 vs 51.0 ±16.5 p=0.015), GPT (79.6 ± 20.7 vs 67.4 ± 14.4, p=0.008), Total Billirubine (1.68 ± 1.78 vs 1.12 ± 1.16, p=0.021). There were no significant increases on Albumin (4.39 ± 0.76 vs 4.51 ± 0.57), Cholesterol (192.6 ± 53.1 vs 199.7 ± 62.4), platelet (182.8 ± 77.0 vs 186.8 ± 75.9).Threre were no significant decreases Forns score (5.98 ± 2.16 vs 5.79 ± 2.50, p= 0.124). There were 9 patients who had fibrosis mild-moderate category led to non fibrosis with p value = 0.046. Conclusions : Short-term pentoxifylline therapy as anti-fibrotic for patients with chronic hepatitis B based on forns score is not fully significant. However it is effective to achieve the decreasing of GOT, GPT and Billirubin

Latar Belakang: Hepatitis kronis B berlanjut menjadi fibrosis hati dan akhirnya berkembang menjadi sirosis hati dan penyakit hati tahap akhir. Fibrosis hati proses reversibel dan pemahaman patogenesis fibrosis telah membuka peluang penggunaan terapi anti fibrosis. Sekarang ini, belum tersedia terapi kuratif untuk fibrosis hati dan pasien tergantung transplantasi. Sehingga dibutuhkan farmakoterapi anti-fibrotik. Pentoxifylline telah dipostulatkan bekerja sebagai anti-fibrosis dengan menghambat proliferasi HSC dan sintesa kolagen pada invitro dan invivo. Tujuan: Untuk mengetahui penurunan skor Forns pada penderita hepatitis kronis B setelah pemberian pentoxifylline. Metode : 14 pasien hepatitis kronis B dengan peningkatan GPT (>1.3 kali) dilakukan secara uji klinis dengan penilaian skor Forns sebelum dan sesudah pemberian pentoxifylline dengan dosis 3x400 mg selama 4 minggu. Hasil : Setelah 4 minggu terapi, penurunan berrmakna pada SGOT (65.1 ± 37.3 vs 51.0 ± 16.5 p=0.015), SGPT (79.6 ± 20.7 vs 67.4 ± 14.4, p=0.008), bilirubin total (1.68 ± 1.78 vs 1.12 ± 1.16, p=0.021). Peninggian tidak bermakna pada Albumin (4.39 ± 0.76 vs 4.51 ± 0.57), kolesterol (192.6 ± 53.1 vs 199.7 ± 62.4), trombosit (182.8 ± 77.0 vs 186.8 ± 75.9). Penurunan tidak bermakna skor Forns (5.98 ± 2.16 vs 5.79 ± 2.50, p= 0.124), Sebanyak 9 pasien kategori fibrosis ringan-sedang menjadi 4 orang kategori bukan fibrosis dengan nilai p=0.046. Kesimpulan : Terapi jangka pendek pentoxifylline sebagai anti-fibrosis pada terhadap penderita hepatitis kronis B berdasar skor Forns adalah tidak sepenuhnya bermakna. Namun efektif mencapai penurunan SGOT, SGPT dan bilirubin.