Kadar Fibronectin Plasma pada Penderita Sirosis Hati Berdasarkan Keparahan

Abstract

Background: Patients with liver cirrhosis experienced dysfunction in their immune system, and the increased susceptibility to infection had relationship with the level of liver dysfunction. About 25-50% death among liver cirrhosis (LC) patients is due to infection. In human body defence mechanism, plasma fibronectin acts as opsonin for Kuppfer cells. Patients with liver disease frequently have pFN deficiency and decreased of pFN availability is an important factor causing Kuppfer cells failure. Concentration of pFN between patients with LC with different severity according to CTP and MELD score, had never been studied before.

Aim: To obtain the pFN concentration among LC patients with different severity according to CTP and MELD score.

Material and Method: This cross sectional study, in the period of August 2007 until March 2008, included male gender outpatients and inpatients with LC admitted to Division of Gastroenterohepatology- Departement of Internal Medicine/ H Adam Malik General Hospital –Medan, and private clinic of the Gastroenterohepatology consultant in Medan. Diagnosis was made by history, physical examination, laboratory examination and USG.

Result: Among 38 patients (male gender), the patients with mild LC (CTP score < 8, MELD score < 14) were 20 and 17 patients consecutively, and severe LC (CTP score ≥ 8, MELD score ≥14) were 18 and 21 patients. Concentration of pFN of the severe LC patients were lower significantly from the mild LC patients (p<0,05). The pFN concentration had significant negative correlation with prothrombin time and INR. Concentration of pFN was lower among patients with splenomegaly, but no significant correlation was found between pFN and spleen length.

Conclusion: Plasma fibronectin concentration was lower among the severe cirrhotic patients. Low pFN concentration in LC patients is more relevant due to synthetic failure of the liver.

Latar Belakang: Pada SH yang sudah lanjut terjadi defek dan disfungsi pada sistem imunnya dan peningkatan kerentanannya terhadap infeksi berkaitan dengan tingkat disfungsi hati. Sebanyak 25-50% kematian penderita SH disebabkan oleh infeksi. Dalam mekanisme pertahanan tubuh, fibronektin plasma (pFN) merupakan opsonin bagi sel-sel Kuppfer.Penderita penyakit hati sering mengalami defisiensi pFN dan berkurangnya ketersediaan FN merupakan faktor penting kegagalan sel-sel Kuppfer. Kadar pFN pada SH yang berbeda keparahannya berdasarkan skor CTP dan MELD belum pernah diteliti sebelumnya.

Tujuan: Untuk memperoleh data kadar FN pada penderita SH yang berbeda keparahannya menurut skor Child-Turcotte Pugh dan skor MELD.

Bahan dan Cara: Penelitian ini dilakukan secara potong lintang mulai Desember 2007 – Maret 2008, dan mengikutsertakan pasien laki-laki penderita SH rawat jalan poliklinik dan rawat inap di Divisi Gastroenterohepatologi Departemen Penyakit Dalam RS H Adam Malik Medan serta pasien praktek Spesialis Penyakit Dalam-Konsultan Gastroenterohepatologi di Medan. Diagnosis ditegakkan dengan anamnesis, pemeriksaan fisik, USG dan pemeriksaan laboratorium .

Hasil: Dari 38 pasien SH laki-laki, penderita sirosis hati ringan (skor CTP< 8, skor MELD< 14) masing- masing 20 dan 17 orang secara berurutan, dan sirosis hati berat (skor CTP≥ 8, skor MELD ≥14) 18 dan 21 orang. Kadar pFN pasien sirosis hati berat lebih rendah bermakna daripada penderita sirosis hati ringan (p<0,05). Kadar pFN berkorelasi negatif bermakna dengan waktu prothrombin dan international normalized ratio (INR) Kadar pFN juga lebih rendah di antara pasien dengan splenomegali, namun tidak ditemukan korelasi yang bermakna di antara pFN dengan panjang lien.

Kesimpulan: Kadar pFN lebih rendah pada pasien sirosis hati berat. Rendahnya kadar pFN pada penderita sirosis hati berat lebih relevan disebabkan oleh gangguan sintesis oleh hati.