ABSTRAK
Latar Belakang
Sirosis adalah suatu keadaan patologis yang menggambarkan stadium akhir fibrosis hati yang berlangsung progresif yang ditandai dengan distorsi dari arsitektur hati. Transforming growth factor-beta 1 (TGF-β1) merupakan faktor paling fibrogenik dalam aktivasi sel stelat hepar pada mekanisme fibrogenesis. Adanya peningkatan aktivitas aksis renin-angiotensin-aldosteron intrahepatal yang dipengaruhi oleh TGF-β1 menyebabkan sirkulasi hiperdinamik, dan sklerosis pembuluh darah.
Tujuan Penelitian
Membuktikan dan mengetahui pengaruh pemberian captopril terhadap kadar TGF-β1 dan ketebalan vena porta pada pasien dengan sirosis hati .
Metode Penelitian
Penelitian ini adalah eksperimental Double Blind Randomized Control Trial. Subyek penelitian yang mengikuti hingga selesai 27 pasien sirosis hati (14 captopril; 13 plasebo). Kadar TGF-β1 serum menggunakan ELISA. Monitoring SGOT, SGPT, Ureum, Kreatinin, parameter skor Child-Pugh, serta efek samping dilakukan sebelum dan sesudah uji.. Analisis statistik menggunakan mann whitney test, t test, wilcoxon, product moment pearson dengan signifikansi p<0.05.
Hasil Penelitian
Pemberian captopril menurunkan kadar TGF-β1 (-7772±5502,8 pg/ml; p= 0,001) dan ketebalan vena porta (-0.11±0,24 mm; p=0,022), serta memperbaiki kecepatan aliran vena porta (+8,21±4,25 cm/detik; p=0,001). Namun tidak memperbaiki diameternya (0,96±1,39 mm; p=0,225). Pada plasebo tidak memperbaiki kadar TGF-β1 (p=0,221), ketebalan vena porta (p=0,387), kecepatan aliran vena porta (p=0,849), serta diameternya (p=0,164). Pemberian captopril tidak signifikan memperbaiki prognosis sirosis hati (skor Child-Pugh). Efek samping yang tersering batuk.
Kesimpulan
Pemberian captopril menurunkan kadar TGF-β1 pada pasien sirosis hati dan memberikan efek penurunan ketebalan vena porta.
Kata kunci: captopril, TGF-β1, skor Child-Pugh, ketebalan, kecepatan aliran, diameter.
ABSTRACT
Background
Cirrhosis is a condition pathological end-stage liver fibrosis that characterized by progressive lasted distortion of the liver architecture. Transforming growth factor-beta 1 (TGF-β1) is a factor in most fibrogenic stelate cell mechanisms activator of fibrogenesis in the liver. An increase in the activity of the renin-angiotensin- aldosterone axis intrahepatal influenced by TGF-β1 caused hyperdynamic circulation, and vascular sclerosis.
Objective
This study aimed to prove and determine the effect of captopril on the levels of TGF-β1 and the portal vein thickness in patients with liver cirrhosis.
Methods
This research is experimental double blind randomized control trial. Subjects of this study were followed until completion were 27 patients with liver cirrhosis (14 captopril; 13 placebos). TGF-β1 levels in serum using ELISA. Monitoring of SGOT, SGPT, urea, creatinine, Child-Pugh score parameters, and side effects before and after the test. Statistical analysis used the Mann Whitney test, t test, Wilcoxon, Pearson product moment with significance of p <0.05.
Result
Captopril reduced levels of TGF-β1 (-7772±5502.8 pg/ml; p=0.001) and portal vein thickness (-0,11±0.24 mm; p=0.022), as well as improve the portal venous flow velocity (+8,21±4.25cm/sec; p=0.001). But it did not improve diameter (0,96 ± 1.39 mm; p = 0.225). Placebo group did not improve the levels of TGF-β1 (p=0.221), portal vein thickness (p=0.387), portal venous flow velocity (p=0.849), as well as the diameter (p=0.164). Administration of captopril did not significantly improve the prognosis of liver cirrhosis (Child-Pugh score). The most common side effects are cough.
Conclusion
Captopril reduced levels of TGF-β1 in patients with liver cirrhosis and decrease portal vein thickness.
Keywords: captopril, TGF-β1, Child-Pugh score, thickness, flow velocity, diameter
