Tesis

Perubahan Derajat Steatosis Hati Dan Profil Lipid Pasien Hepatitis C Pada Sustained Virological Response 12 = Changes in Hepatic Steatosis Degrees and Lipid Profiles in Hepatitis C Patients at Sustained Virological Response 12.

Latar Belakang: Saat ini hubungan antara kejadian SVR12 pasien hepatitis C, profil lipid, dan steatosis hati masih belum jelas. Hasil publikasi yang ada saat ini masih tidak konsisten mengenai perubahan nilai parameter tersebut pasca SVR12. Di Indonesia sendiri, belum ada penelitian yang mengevaluasi kejadian steatosis hati pasca SVR12, padahal karakteristik populasi di Indonesia berbeda dengan populasi negara lain. Penelitian ini bertujuan untuk meneliti perubahan derajat steatosis hati dan profil lipid pada pasien hepatitis C saat SVR12 dan mencari hubungannya. Metode: Penelitian dengan desain longitudinal, before and after study yang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Penelitian dilakukan selama 1 tahun di Poliklinik Hepatobilier, Ruang Prosedur Terpadu (RPT) Divisi Hepatobilier. Pasien yang memenuhi kriteria inklusi akan diikutsertakan dan diperiksa profil lipid dan nilai controlled attenuated parameter sebelum dan sesudah terapi. Hasil: Rerata SD usia sampel penelitian adalah 45±8.78 tahun. Subjek sebagian besar (62%) berjenis kelamin laki-laki. Nilai rerata SD CAP meningkat, sebelum terapi 196±49.36 dB/m dan setelah terapi 227±47.11 dB/m. Nilai rerata SD kolesterol total meningkat, sebelum terapi 166±40.30 mg/dL dan setelah terapi 190±42.58 mg/dL. Nilai rerata SD trigliserida, sebelum terapi 94±45.39 mg/dL dan setelah terapi 109±49.83 mg/dL. Nilai rerata SD HDL meningkat, sebelum terapi 44.4±15.02 mg/dL dan setelah terapi 47.0±17.20 mg/dL. Nilai rerata SD LDL meningkat, sebelum terapi 109.48±39.57 mg/dL dan setelah terapi 130.88±34.32 mg/dL. Tidak ditemukan korelasi korelasi delta berbagai jenis kolesterol dengan delta CAP. Ditemukan adanya korelasi negatif antara nilai CAP pada pasien hepatitis C sebelum terapi dan perubahan nilai CAP sesudah terapi DAA. Terdapat penurunan nilai rerata SD kekakuan hati, sebelum terapi 6.90±2.34 kPa dan setelah terapi 5.35±1.79 kPa. Terdapat penurunan nilai median APRI, sebelum terapi 0.50 (0.3 – 0.7) dan setelah terapi 0.20 (0.20 – 0.30). Simpulan: 1) Terdapat perbedaan derajat steatosis hati sebelum terapi dan saat SVR12 pada pasien hepatitis C yang mendapat terapi DAA. 2) Terdapat perbedaan kadar kolesterol total, kolesterol HDL, kolesterol LDL, dan trigliserida sebelum terapi dan saat SVR12 pada pasien hepatitis C yang mendapat terapi DAA. 3) Tidak terdapat korelasi perubahan kadar kolesterol total, kolesterol HDL, kolesterol LDL, dan trigliserida terhadap derajat steatosis hati saat SVR12.
Kata Kunci: Steatosis Hati, Hepatitis C, Sustained Virological Response, Direct Acting Antiviral, profil lipid.


Background: Currently, the relationship between hepatitis C patients' SVR12 events, lipid profiles and liver steatosis remains unclear. Current publications are inconsistent regarding the changes in these parameters after SVR12. In Indonesia alone, there are no studies evaluating the incidence of liver steatosis after SVR12, even though the characteristics of the population in Indonesia are different from those in other countries. This study aims to examine changes in the degree of hepatic steatosis and lipid profile in hepatitis C patients during SVR12 and find out the relationship. Method: Longitudinal design, before and after study conducted at Cipto Mangunkusumo Hospital (RSCM). The study was conducted for 1 year at the Hepatobiliary Polyclinic, Integrated Procedure Room of the Hepatobiliary Division. Patients who met the inclusion criteria were included and examined for lipid profile and controlled attenuated parameter values before and after therapy. Results: The mean age SD is 45±8.78 years. Subjects were mostly (62%) male. The mean SD value of CAP increased, before therapy 196±49.36 dB/m and after therapy 227±47.11 dB/m. The mean SD value of total cholesterol increased, before therapy 166±40.30 mg/dL and after therapy 190±42.58 mg/dL. The SD mean value of triglycerides, before therapy 94±45.39 mg/dL and after therapy 109±49.83 mg/dL. The mean SD value of HDL increased, before therapy 44.4±15.02 mg/dL and after therapy 47.0±17.20 mg/dL. The mean SD value of LDL increased, before therapy 109.48±39.57 mg/dL and after therapy 130.88±34.32 mg/dL. There was no correlation between the delta of various types of cholesterol and the delta of CAP. There was a negative correlation between CAP values in hepatitis C patients before therapy and changes in CAP values after DAA therapy. There was a decrease in the mean SD value of liver stiffness, before therapy 6.90±2.34 kPa and after therapy 5.35±1.79 kPa. There was a decrease in the median APRI value, before therapy 0.50 (0.3 - 0.7) and after therapy 0.20 (0.20 - 0.30). Conclusion: 1) There is a difference in the degree of liver steatosis before therapy and after SVR12 in hepatitis C patients who received DAA therapy. 2) There are differences in total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride levels before therapy and after SVR12 in hepatitis C patients who received DAA therapy. 3) There is no effect of changes in total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides before therapy and after SVR12 on the degree of liver steatosis after SVR12.
Key Words: Liver Steatosis, Hepatitis C, Sustained Virological Response, Directacting Antivirals, lipid profile.