Tesis

Korelasi Rasio Firmicutes/Bacteroidetes dengan Nilai Controlled Attenuation Parameter (CAP) dan Transient Elastography (TE) pada Pasien Non Alcoholic Fatty Liver Disease (NAFLD) = The Correlation between Firmicutes/Bacteroidetes Ratio with Controlled Attenuation Parameter (CAP) and Transient Elastography (TE) Value in the Non Alcoholic Fatty Liver Disease (NAFLD) Patients.

Latar Belakang: Non alcoholic fatty liver disease (NAFLD) merupakan kondisi perlemakan hati yang merupakan salah satu faktor risiko karsinoma hepatoselular (KSH). NAFLD melibatkan berbagai faktor dalam patogenesisnya, salah satunya mikrobiota saluran cerna. Disbiosis mikrobiota saluran cerna dianggap sebagai faktor utama dalam peristiwa disregulasi sistem imun dan inflamasi pada patogenesis NAFLD. Tujuan: Studi ini bertujuan untuk melihat profil dan konfigurasi mikrobiota saluran cerna pasien dengan NAFLD dan pengaruhnya terhadap nilai kondisi fibrosis dan stratosis hati yang tercermin dalam nilai controlled attenuation parameter (CAP) dan transient elastography (TE). Metode: Dilakukan studi potong lintang analitik terhadap 37 pasien dengan NAFLD yang memenuhi kriteria inklusi di Rumah Sakit Cipto Mangunkusumo pada Desember 2018 hingga Maret 2019. Dilakukan anamnesis, wawancara food recall, pemeriksaan fisik, pemeriksaan laboratorium, pemeriksaan CAP-TE, dan pengambilan sampel feses pada pasien subjek penelitian. Mikrobiota saluran cerna disekuensing dengan Next-Generation Sequencing (NGS) platform Miseq (Illumina). Hasil: NAFLD lebih dominan pada wanita dan penderita penyakit sindrom metabolik. Firmicutes, Bacteroidetes, dan Proteobacteria berturut-turut merupakan filum dengan proporsi terbesar. Disbiosis mikrobiaota saluran cerna didapatkan pada separuh dari sampel subjek penelitian. Rasio Firmicutes/Bacteroidetes (RFB) pada setiap pasien berbeda-beda dan tidak berkorelasi secara signifikan terhadap variabel sindrom metabolik. Diversitas mikrobiota saluran cerna didapatkan menurun pada pasien NAFLD dengan trigliserida tinggi dan obesitas sentral. Simpulan: Sejumlah mikrobiota saluran cerna pada tingkat taksonomi yang berbeda memiliki korelasi positif maupun negatif terhadap fibrosis dan steatosis.
Kata kunci: NAFLD, Rasio Firmicutes/Bacteroidetes, disbiosis mikrobiota saluran cerna


Background: Non alcoholic fatty liver disease (NAFLD) is fatty liver condition that can lead to hepatocellular carcinoma (HCC). NAFLD is multifactorial component in its pathogenesis, one of which is gut microbiota. Dysbiosis of gut microbiota is considered as main factor in the dysregulation of immune system and inflammatory condition in the pathogenesis of NAFLD. Aim: This study aim to investigate the profile and configuration of gut microbiota in patient with NAFLD dan its correelation withfibrosis and steatosis condition as reflected in controlled attenuation parameter (CAP) dan transient elastography (TE) value. Method: cross sectional study was done upon 37 NAFLD patients in Cipto Mangunkusumo National General Hospital from December 2018 to March 2019. All subjects undergone food recall examination, physical and laboratory examination, CAP-TE value measurement, and fecal sample examination. The gut microbiota was investigated through 16s RNA sequensing by Next-Generation Sequencing (NGS) platform Miseq (Illumina). Result: NAFLD was predominant in female subjects and those with metabolic syndrome. Firmicutes, Bacteroidetes, dan Proteobacteria was the predominant phylum consecutively. Dysbiosis was appeared in half of the study subjects. The Ratio of Firmicutes/Bacteroidetes was different in each patients and has no significnat correlation with metabolic syndrome variables. The diversity of gut microbiota was decresed in NAFLD patients with high tryglicerides and central obesity. Conclusion: Certain gut microbiota at different taxonomy level have positive and negative correlation with fibrosis and steeatosis.
Key word: NAFLD, Ratio of Firmicutes/Bacteroidetes, dysbiosis of gut microbiota