Korelasi Kadar Trombopoietin Serum dengan Fibrosis Hati pada Penderita Hepatitis Kronik

Abstract

Background : Thrombopoetin (TPO) is a cytokine mainly produced in the liver and is the principal regulator in the humoral control mechanism of thrombopoesis. Presumably TPO production is not adequate in patients suffering from severe necroinflammation and advanced liver fibrosis in chronic hepatitis. Studies concerning the association of serum TPO levels and the degree of disease severity (liver fibrosis) are still controversial. Objective : To identify the correlation between serum TPO levels and the degree of liver fibrosis, and to determine whether serum TPO levels can be used as a marker of the degree of liver fibrosis in chronic hepatitis patients. Methods: This study was of an analytical cross-sectional design. We examined the relationship between the serum TPO levels and the degree of liver fibrosis in 62 chronic hepatitis patients between June 2006 and March 2008. The number of patients who fulfilled the inclusion criteria were 55 ; 38 were hepatitis B patients, 15 were hepatitis C patients, 2 were hepatitis non B and non C patients. There were 22 women and 33 men, with an age range from 18 to 70 years. 11 healthy subjects and 10 liver cirrhosis patients were also included in this study. The serum TPO levels of each subject was examined by using the Quantikine Human TPO Immunoassay, and a liver biopsy was performed to determine the degree of liver fibrosis by classifying it according to the Metavir scoring system. Statistical analysis of the relationship between serum TPO levels and the liver damage severity based on the degree of fibrosis, was performed by using the Spearman' s correlation test. The sensitivity and specificity of serum TPO in diagnosing the degree of liver fibrosis was subsequently determined. Results : By the Spearman's correlation test, we found that serum TPO levels were correlated negatively with the degree of liver fibrosis in a very significant fashion (r = -0.284 ; p <0.05). At serum TPO level of 16.01 pg/ml or lower, the sensitivity and spesificity of serum TPO for diagnosing the severity of the fibrosis were 64.1 % and 70.3 %, respectively, when the disease process was at an F3 or greater level (p = 0,003 ). In addition, there was a significant difference between the degree of liver fibrosis and platelet count, Fl : 222.000 ± 26153, F2 : 223.590 ± 35000, F3 : 170.681 ± 19948, and F4 : 990.000 ± 43464 respectively (p < 0.0001). There was a significant negative correlation between the degree of fibrosis with thrombocyte level (r = - 0 ,783 and p = 0,001). The more severe the degree of fibrosis, the lower the thrombocyte count. Conclusion : There is a significant negative correlation between serum TPO levels and the degree of liver fibrosis in chronic hepatitis patients. Serum TPO level at a cut off of 16.01 pg/ml can be helpful in diagnosing F3 or greater severity of fibrosis.

There is a significant negative correlation between the degree of liver fibrosis and platelet count.