Tesis

Peran Neutrofil dan Platelet pada Pemantauan Nyeri Pasien Endometriosis yang Mendapatkan Terapi Progestin – Kajian Terhadap Systemic Inflammation Response Index (SIRI) dan Systemic Immune Inflammation Index (SIII) = The Role of Neutrophils and Platelets in Monitoring Pain Among Endometriosis Patients Receiving Progestin Therapy – An Evaluation of the Systemic Inflammation Response Index (SIRI) and Systemic Immune Inflammation Index (SIII).

Latar belakang: Endometriosis adalah penyakit inflamasi kronis yang ditandai oleh implantasi jaringan endometrium di luar kavum uteri. Proses patogenesis endometriosis melibatkan Repeated Tissue Injury and Repair (ReTIAR) yang memicu aktivasi sel imun, khususnya neutrofil dan platelet, yang berperan dalam angiogenesis, neurogenesis, dan pembentukan fibrosis. Terapi standar saat ini menggunakan progestin seperti dienogest untuk menekan aktivitas estrogen, namun banyak pasien masih mengalami nyeri meskipun kadar estrogen telah terkendali, sehingga diperlukan marker objektif untuk memantau respons terapi. Systemic Inflammation Response Index (SIRI) dan Systemic Immune Inflammation Index (SIII) merupakan marker inflamasi baru yang dihitung dari jumlah leukosit, neutrofil, monosit, dan platelet, serta mudah diperoleh dari pemeriksaan darah rutin.. Tujuan: (1) Mengetahui hubungan antara kadar SIRI pada pasien endometriosis dengan skala nyeri. (2) Mengetahui hubungan antara kadar SIII pada pasien endometriosis dengan skala nyeri. Metode: Dilakukan studi potong lintang terhadap pasien dengan endometriosis yang mendapatkan terapi progestin di Poliklinik Endokrinologi Reproduksi RSCM. Didapatkan 50 kasus yang masih merasakan nyeri, dan 50 kasus yang tidak nyeri. Dilakukan pengambilan darah untuk pemeriksaan darah perifer lengkap dan hitung jenis leukosit. Berdasarkan hasil tersebut dilakukan kalkulasi SIRI (jumlah netrofil x jumlah monosit / jumlah limfosit) dan SIII (jumlah netrofil x jumlah platelet / jumlah limfosit). Hasil SIRI dan SIII dibandingkan pada kedua kelompok. Hasil: Terdapat perbedaan bermakna untuk SIRI pada kelompok nyeri dibandingkan tidak nyeri (median 1009.3 vs 801, p=0.019). Tidak ada perbedaan bermakna untuk SIII pada kelompok nyeri dibandingkan tidak nyeri (median 718.06 vs 641.65, p=0.188). CutoffSIRI untuk menilai nyeri adalah sebesar 584.65. Kesimpulan: Terdapat hubungan antara kadar SIRI pada pasien endometriosis dengan skala nyeri VAS dan Endopain 4D, dengan nilai cut-off584.65.
Kata kunci: Endometriosis, Systemic Inflammation Response Index (SIRI), pemantauan terapi


Background: Endometriosis is a chronic inflammatory disease characterized by the implantation of endometrial tissue outside the uterine cavity. The pathogenesis of endometriosis involves Repeated Tissue Injury and Repair (ReTIAR), which triggers the activation of immune cells, particularly neutrophils and platelets, that play key roles in angiogenesis, neurogenesis, and fibrosis formation. The current standard therapy uses progestins, such as dienogest, to suppress estrogen activity. However, many patients continue to experience pain even when estrogen levels are controlled, highlighting the need for an objective marker to monitor therapeutic response. The Systemic Inflammation Response Index (SIRI) and Systemic Immune Inflammation Index (SIII) are novel inflammatory markers calculated from leukocyte, neutrophil, monocyte, and platelet counts, and can be easily obtained through routine blood tests. Aim: (1) To determine the relationship between SIRI levels and pain scores in patients with endometriosis. (2) To determine the relationship between SIII levels and pain scores in patients with endometriosis. Methods: A cross-sectional study was conducted among endometriosis patients receiving progestin therapy at the Reproductive Endocrinology Clinic of RSCM. A total of 50 patients who reported persistent pain and 50 patients without pain were included. Blood samples were collected for complete peripheral blood counts and leukocyte differentials. SIRI was calculated as: (neutrophil count × monocyte count) / lymphocyte count, and SIII as: (neutrophil count × platelet count) / lymphocyte count. SIRI and SIII results were compared between the two groups. Results: A significant difference was found in SIRI between the pain and non-pain groups (median 1009.3 vs 801, p = 0.019). No significant difference was observed for SIII between the two groups (median 718.06 vs 641.65, p = 0.188). The cut-off value of SIRI for predicting pain was 584.65. Conclusion: There is a relationship between SIRI levels and pain scores (VAS and Endopain 4D) among endometriosis patients, with a cut-off value of 584.65.
Keywords: Endometriosis, Systemic Inflammation Response Index (SIRI), therapy monitoring