Tesis

Hubungan Hitung Jumlah Leukosit Jaringan Vena dengan Time Refluks Vena Saphena Magna pada Pasien Bedah Pintas Arteri Koroner = Correlation between Vein Tissue Leukocyte Count and Great Saphenous Vein Reflux Time in Coronary Artery Bypass Graft Patients

Latar belakang. Abnormalitas fungsi vena terkait inflamasi dan hipertensi vena merupakan
dasar patofisiologi insufisiensi vena kronik. Pembuktian hubungan faktor inflamasi lokal
pada jaringan vena dengan fungsional vena menjadi penting ketika vena yang diteliti akan
menjadi konduit vena pada Bedah Pintas Arteri Koroner (BPAK) dan evaluasi patensinya
berpengaruh pada mortalitas dan morbiditas pasien Penyakit Jantung Koroner (PJK).

Metode. Penelitian ini merupakan studi potong lintang dari 35 sampel jaringan vena saphena
magna pasien PJK yang diambil untuk konduit vena pada BPAK dan telah diperiksa IVK
menggunakan Duplex Ultrasound (DUS) dengan parameter time refluks, periode bulan
September sampai November 2014 di Pusat Jantung Nasional Harapan Kita. Untuk analisa
hitung jumlah leukosit dilakukan pewarnaan Hematoxyllin eosin pada jaringan vena oleh ahli
patologi anatomi. Analisis statistik dilakukan untuk mencari hubungan antara hitung jumlah
leukosit jaringan vena dengan time refluks vena saphena magna.

Hasil. Analisa statistik dengan Chi square didapatkan perbedaan bermakna peningkatan
jumlah leukosit jaringan vena pada pasien insufisiensi vena kronik dibandingkan normal
(52,63 % vs 18,755) dengan nilai P 0,039. Analisa lebih lanjut dengan rasio odd, dimana
pasien dengan peningkatan jumlah leukosit jaringan vena memiliki 4 kali lipat kemungkinan
menderita insufisiensi vena kronik (Crude OR 4,81; CI 95% 1.02 - 22.57; P value 0.046), dan
setelah dianalisa menggunakan variabel perancu usia, jenis kelamin, Diabetes mellitus,
Hipertensi, Perokok, Dislipidemia, adjusted OR bertambah menjadi 6 kali lipat (Adjusted OR
6,66; CI 95% 1.16 - 38.31; P value 0.033)

Kesimpulan. Terdapat hubungan antara nilai inflamasi lokal dengan parameter hitung jumlah
lekosit jaringan vena dengan fungsi vena pada pasien insufisiensi vena kronik dengan
parameter time refluks yang diperiksa dengan DUS.
Kata kunci: leukocyte trapping, hipertensi vena, insufisiensi vena kronik, bedah pintas arteri
koroner


Background: Venous function abnormality associated with inflammation and venous
hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving
the relationship between local inflammation factors in venous tissue and its function became
an important point because the veins studied are used as a conduit for Coronary Artery
Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and
morbidity rate in Coronary Artery Disease (CAD).

Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV)
tissues taken as conduit for CABG procedure from CAD patients that have been previously
examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November
2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with
Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent
anatomical pathologist. Reflux time and vein tissue leukocyte count results were then
grouped into 2 categories each and analysed with chi-square test to assess the relationship
between the two variables

Result: There was significant difference of elevated leukocyte count evaluated in patients
with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%)
(p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4
times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57;
p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes,
hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR
6.66; 95% CI 1.16 to 38.31; p=0.033).

Conclusion: There is significant relationship between local inflammatory factors, evaluated
using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI
patients.
Keywords: leukocyte trapping, venous hypertension, chronic venous insufficiency, coronary
artery bypass surgery