Disertasi

Keselarasan Skor USG dan Skor MRI serta Hubungannya dengan Kadar C-Terminal Telopeptide Type II Collagen Urin Dalam Deteksi Dini Artropati Hemofilik Lutut. = Association between Ultrasonographic and Magnetic Resonance Imaging Score and Its Correlation to Urinary C-Terminal Telopeptide Type II Collagen Level in Early Detection of Knee Haemophilic Arthropathy.

Terjadinya artropati lutut dini pada penyandang hemofilia memerlukan evaluasi yang objektif dan terukur. Sistem skor MRI baku dari International Prophylaxis Study Group World Federation of Hemophilia (IPSG-WFH) dapat mengevaluasi artropati hemofilik (AH), tetapi sulit untuk diterapkan secara rutin karena tidak banyak tersedia, biaya mahal, dan membutuhkan sedasi. Sistem skor USG yang ada relatif kompleks dan belum ada konsensus, selain juga kemampuan USG yang terbatas untuk evaluasi kartilago. Untuk itu dibutuhkan sistem skor USG baru yang mudah laksana, tetapi juga berkorelasi baik dengan sistem skor MRI yang ada dan dengan kadar C-terminal telopeptide type II collagen (CTX-II) urin sebagai penanda biokimiawi kerusakan kartilago. Penelitian ini bertujuan untuk mendapatkan sistem skor USG yang baru untuk AH lutut tahap dini serta membuktikan keselarasannya dengan skor MRI IPSG-WFH dan kadar CTX-II urin. Penelitian dilakukan di RSUPN Cipto Mangunkusumo Jakarta dan Lembaga Biologi Molekular Eijkman pada bulan Februari 2015–bulan Oktober 2016. Formulasi skor USG yang baru dilakukan berdasarkan studi pustaka dan peer review. Sebanyak 27 lutut AH tahap dini penyandang hemofilia A berat (median usia 10,5 tahun; rentang 6–16 tahun) diperiksa menggunakan radiografi, USG dan MRI. USG dinilai dengan skor USG yang baru, dan MRI nilai dengan skor MRI IPSG-WFH. Sebanyak 40 lutut AH tahap dini penyandang hemofilia A berat (median usia 10 tahun; rentang 6–17 tahun) diperiksa menggunakan radiografi dan USG. Kadar CTX-II urin diperiksa dengan metode ELISA menggunakan kit Urine Cartilapsâ. Uji korelasi dilakukan menggunakan uji Spearman Rho. Skor USG yang baru mengevaluasi efusi sendi/hemartrosis dalam 3 derajat, hipertrofi sinovium dalam 2 derajat, hipervaskularisasi sinovium (Power Doppler) dalam 1 derajat, deposisi hemosiderin dalam 2 derajat, dan defek kerusakan kartilago dalam 2 derajat. Terdapat korelasi antara skor USG dan skor MRI (p = 0,012) dengan kekuatan korelasi sedang (R = 0,431) dan adjusted R = 0,868. Tidak ditemukan korelasi skor USG dengan kadar CTX-II urin (p = 0,360 dan R = 0,058). Telah dikembangkan sistem skor USG yang baru untuk AH lutut, yang berkorelasi dengan sistem skor MRI IPSG-WFH. Tidak ditemukan korelasi skor USG yang baru dengan kadar CTX-II urin.
Kata kunci: Artropati hemofilik lutut, C-terminal telopeptide type II Collagen urin, skor MRI, skor US.


Early knee arthropathy in haemophilic individual requires an objective measures. MRI scoring system was introduced by the International Prophylaxis Study Group World Federation of Hemophilia (IPSG-WFH), but it is limited to be used in daily practice due to high cost, less accessible and the need of sedation for children. Available US scoring systems are promising, but they are relatively complex technically and no consensus achieved so far on which score is preferred, considering also the limitation of US in evaluation of cartilage. New US scoring system is needed that easier to be applied, correlate well with the already established MR scoring system of IPSG-WFH and with the urinary C-terminal telopeptide type II collagen (CTX-II) as a biomarker for cartilage degradation. This study aimed to develop a new US scoring system for early-stage knee haemophilic arthropathy (HA) and to prove its association with MRI scoring system from IPSG-WFH and urinary CTX-II level. Research was done in Cipto Mangunkusumo General Hospital Jakarta and Eijkman Institute of Mollecular Biology from February 2015 until October 2016. Development of the new US scoring system was based on literature studies and peer review. Early knee arthropathy of 27 boys with severe haemophilia A (median age 10,5 years; range 6–16 years) were imaged by radiography, US and MRI. US was scored using the new US scoring system, and MRI was scored using the IPSGWFH MRI scoring system. Early knee arthropathy of 40 boys with severe haemophilia A (median age 10 years; range 6–17 years) were imaged by radiography and US. Urinary CTX-II was measured using ELISA Urine Cartilapsâ. Correlation was tested using Spearman Rho test. New US scoring system was develop to evaluate joint effusion/ haemarthrosis in 3 degree of severity, synovial hypertrophy in 2 degree, synovium hypervascularization (Power Doppler), hemosiderin deposition in 2 degree, and cartilage damage in 2 degree. Moderate correlation was found between US score and MRI score (p = 0,012; R = 0,431; adjusted R 2 = 0,868). There was no correlation between US score and urinary CTX-II level (p = 0,360; R = 0,058). New US scoring system was developed for knee HA, which correlated with the MRI IPSG-WFH scoring system. There was no correlaton between the new score with urinariy CTX-II level.
Keywords: Knee haemophilic arthropathy, MRI scoring system, US scoring system, urinary C-terminal telopeptide type II Collagen