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Abstrak :
Latar belakang dan tujuan: Fibrosis hepar merupakan hal yang perlu diketahui untuk memulai terapi antiviral pada pasien hepatitis C kronik. Pemeriksaan USG Doppler yang bersifat non invasif, tersedia luas dan relatif murah dipertimbangkan sebagai metode alternatif untuk menentukan derajat fibrosis di daerah yang tidak memiliki fibroscan. Parameter splenic artery pulsatility index (SAPI) dipikirkan dapat digunakan sebagai indikator derajat fibrosis. Namun saat ini belum ditemukan nilai titik potong SAPI untuk populasi di Indonesia. Metode: Studi observasional potong lintang dilakukan pada 34 pasien dengan hepatitis C kronik di Divisi Hepatologi Departemen Ilmu Penyakit Dalam Rumah Sakit Cipto Mangunkusumo dalam kurun waktu Desember 2015 hingga Februari 2016. Indeks dan parameter Doppler lainnya merupakan data primer. Subjek dibagi menjadi dua kelompok, yaitu kelompok fibrosis non signifikan dan kelompok fibrosis signifikan. Uji komparatif dilakukan untuk membandingkan rerata indeks dan parameter Doppler lainnya diantara kedua kelompok tersebut. Analisis kurva receiver operating characteristic (ROC) dilakukan pada SAPI untuk mendapatkan nilai sensitifitas dan spesifisitasnya. Hasil: Median SAPI pada kelompok fibrosis signifikan adalah 1.02 dengan range 0.7-1.8 sedangkan median SAPI pada kelompok fibrosis non signifikan adalah 0.89 dengan range 0.7-1.3 dengan nilai p=0.021. Dengan analisis ROC didapatkan titik potong indeks 0.96 yang memberikan sensitifitas 73.9% dan spesifisitas 81.8% untuk membedakan kelompok fibrosis signifikan dan fibrosis non signifikan. Kesimpulan: Terdapat hubungan yang bermakna antara indeks SAPI secara USG dengan derajat fibrosis yang didapat dari fibroscan dan indeks tersebut dapat digunakan sebagai indikator fibrosis signifikan dengan akurasi yang cukup tinggi. ...... Background and Objective: Liver fibrosis needs to be evaluated in order to begin anti viral therapy in chronic hepatitis C patients. Doppler ultrasound which is non invasive, widely available and relatively cheap is being considered as an alternative method to determine the degree of fibrosis in areas which do not have a fibroscan available. Splenic artery pulsatility index (SAPI) can be used as an indicator of significant fibrosis, however the cut off value for Indonesian population has yet to be determined. Method: A cross-sectional observational study is conducted in 34 patients with chronic hepatitis C in the Hepatology Division Department of Internal Medicine Cipto Mangunkusumo Hospital during December 2015 to February 2016. The index and other Doppler parameters are primary data. Subjects are divided into two groups: significant fibrosis group and non significant fibrosis group. Comparative test is conducted to compare the mean index and other Doppler parameters among the two group. Analysis of receiver operating characteristic (ROC) curve was performed on parameters that are statistically significant in order to obtain the sensitivity and specificity value. Results: Median SAPI in significant fibrosis group is 1.02 with a range of 0.7-1.8 while the median SAPI in non significant group is 0.89 with a range of 0.7-1.3, p=0.021. From ROC curve analysis, we obtained the optimal cutting point index 0.96 which gives 73.9% sensitivity and 81.8% specificity to differentiate significant fibrosis group and non significant fibrosis group. Conclusion: There is a significant association between SAPI which is obtained by Doppler and the degree of fibrosis obtained from fibroscan which can be used as an indicator for significant liver fibrosis with quite high accuracy.

Abstrak :
Chronic hepatitis B is still a major health problem in Indonesia. Unfortunately, to date, treatment of chronic HBV (Hepatitis B virus) infection had not shown satisfactory result. Monotherapy with alpha interferon or lamivudine have been widely used as treatment of chronic HBV. However, treatment response to Alpha interferon in Asian people was not satisfactory (15% - 20%), while monotherapy with lamivudine was not sufficient to eradicate HBV in chronically infected patients and commonly induce drug resistance. The occurrence of chronic hepatitis B resistant to lamivudine had encouraged development of newer agents such as adefovir, entecavir, emtricitabine and nucleoside analog. New therapeutic strategy using combination therapy should be considered if there is no sufficient response to monotherapy

Abstrak :
ABSTRACT
Background: increased serum alpha fetoprotein (AFP) levels are often found in patients with advanced hepatocellular carcinoma (HCC). Cluster Differentiation 44 (CD44) and CD90 are stem cell biomarkers that have been assumed as the early HCC markers and associated with onset and progressivity of HCC. The study related to HCC stem cell has not been available in Indonesia. The present study aimed to evaluate the expression of cancer stem cell markers (CD44, CD90) and AFP levels in patients with advanced liver disease. Methods: an observational study was conducted in 41 patients with chronic hepatitis B and/or C infection, liver cirrhosis, and HCC at dr. Saiful Anwar General Hospital. CD44 and CD90 expressions were measured with flow cytometry, and AFP serum levels with ELISA. Data on patient characteristics were evaluated using bivariate and multivariate statistical analysis (One-way ANOVA, Mann-Whitney, Chi-Square, Kruskal-Wallis). Data of CD44, CD90 and AFP were analyzed using Kruskal Wallis test with a significance value of p<0.05, and diagnostic power was analyzed using receiver operating characteristic (ROC). Results: the subjects of our study were 16 patients with chronic hepatitis, 15 patients with liver cirrhosis, and 10 patients with HCC. There was a significant difference regarding CD44+CD90+ and AFP among those three groups (p=0.001; p=0.000) specifically in chronic hepatitis compared to liver cirrhosis (p=0.002; p=0.000) and HCC (p=0.002; p=0.000) respectively. ROC analysis showed the best diagnostic power for the combination of CD44+CD90+ and AFP (AUC=0.981; p=0.000). Conclusion: there are higher expressions of CD44+CD90+ and serum AFP levels in patients with HCC compared to the other two groups (those with chronic hepatitis and liver cirrhosis). The combination of both parameters has the best diagnostic power of HCC.

Abstrak :
Latar Belakang : Virus Hepatitis C (HCV) merupakan salah satu penyebab penyakit hati kronik yaitu hepatitis kronik, sirosis dan karsinoma hepatoseiuiar. Dari berbagai penelitian tentang HCV, didapatkan adanya hubungan antara penderita HCV dengan gangguan jiwa/psikiatrik, demikian pula berbagai penelitian tentang HCV dan terapi interferon (IFN) telah dilaporkan adanya efek samping berupa gejala neuropsikiatri seperti, malaise, futique, gangguan cemas, gangguan depresi, tentamen suicide dan psikotik. Prevalensi penelitian terakhir tentang gangguan jiwa pada penderita HCV dengan atau tanpa terapi IFN sekitar 32%. Tujuan : Untuk mendapatkan frekuensi dan jenis gangguan jiwa pada penderita hepatitis C di Poliklinik Hepatologi RSCM dan berbagai variabel yang mempengaruhinya. Metode : Penelitian ini menggunakan rancangan cross sectional, dilakukan pada 85 penderita HCV yang berobat di Poliklinik Hepatologi RSCM. Sampel diambil secara consecutive sampling. Instrumen yang digunakan adalah MINI (Mini International Neuropsychiatric Interview) ICD-10. Analisis statistik dilakukan dengan menggunakan SPSS for windows 10.0 dengan batas kemaknaan 0,05 serta regresi logistik. Hasil dan Simpulan : Frekuensi gangguan jiwa pada penderita HCV adalah 38 subyek (44,7%), dengan jenis gangguan jiwa antara lain ; Episode Depresi 12 subyek (14,0%), Gangguan yang berkaitan dengan Zat Psikoaktif (nikotin) 1 1 subyek (12,9%), Episode Depresi dan Gangguan Ansietas Menyeluruh 7 subyek (8,3%), Gangguan Ansietas Menyeluruh 5 subyek (5,9%) Episode Depresi dan Distimia 1 subyek (1,2%), Episode Depresi , Gangguan Ansietas Menyeluruh dan Gangguan berkaitan dengan Alkohol 1 subyek (1,2%), Gangguan yang berkaitan Zat Psikoaktif dan Gangguan berkaitan dengan Alkohol 1 subyek (1,2%). Pada 21 penderita HCV dengan terapi Interferon (IFN), terdapat 10 subyek mengalami gangguan jiwa. Tidak terdapat penilaian status mental (evaluasi psikiatrik) penderita HCV oleh tim terpaduu, saat sebelum, selama maupun sesudah dilakukan terapi IFN. Pada uji kemaknaan bivariat, terdapat hubungan bermakna antara status pemikahan (p0,001) dan risiko penularan HCV (p,0,000) dengan gangguan jiwa, sedangkan Pada uji kemaknaan multivariat, didapatkan hubungan bermakna antara risiko penularan HCV dengan gangguan jiwa (p0,001). ......Background : Hepatitis C Virus (HCV) is one of the causes of chronic liver disease, such as chronic hepatitis, cirrhosis, and hepatoceliular carcinoma. Several researches conducted on HCV, a correlation between patients with HCV and mental disorder is found, and also several researches on I-ICV and interferon therapy (IFN) have been reported on side effects neuropsychiatry symptoms such as malaise, Fatigue, anxiety disorder, suicidal attempt, and psychotic. The latest research prevalence on mental disorder in patients with HCV, with or without IFN reaches 32 %. Purpose : To attain the frequency and type of mental disorder in patients with HCV found in the hepatology outpatient clinic RSCM and the influencing variables. Method: This research is using cross-sectional design, conducted on 85 HCV patients seeking medical help in the hepatology outpatient clinic. The sample is obtained with consecutive sampling. The chosen instrument is MINI (Mini International Neuropsychiatry Interview) ICD-10. Statistic analysis is using SPSS for windows 10.0 with the level of significance 0.05 and the logistic regression. Result and Conclusion: The frequency of mental disorder in patients with HCV is 38 subjects (44.7%), with the following types of mental disorders; Depression Episode (14.0%), Mental Disorder related to Psychoactive Substance (nicotine) 11 subjects (12.9%), Depression Episode and Generalized Anxiety Disorder 7 subjects (8.3%), Generalized Anxiety Disorder 5 subjects (5.9%), Depression Episode and Mental Disorder related to Alcohol 1 subject (1.2%), Mental Disorder related to Psychoactive Substance and Mental Disorder related to Alcohol 1 subject (1.2%). In 21 HCV patients, with interferon therapy (IFN), 10 subjects suffer from mental disorder. There is no psychiatric evaluation in HCV patients, with a well-integrated team, as in before, during, and after the IFN therapy. In the bivariate test of significance, there is a significant relevance between the marital status (p 0.001) and the risk of transmission (p 0.000) with mental disorder, meanwhile in the multivariate test of significance, a significant correlation is found between the risk of HCV transmission and mental disorder (p 0.001).

Abstrak :
Background: Hepatitis B is endemic in Indonesia and treatment response need to be monitored during and after antiviral therapy. Liver stiffness measurement and alanine aminotransferase to platelet ratio index (APRI) are noninvasive method to detect liver fibrosis available in Indonesia. However, little is known about their ability to evaluate treatment response in chronic hepatitis B (CHB) patients in Indonesia. This study aimed to investigate liver stiffness changes by transient elastography (TE) and APRI before and after one year oral antiviral treatment in CHB patients and the correlation between TE and APRI. Methods: this study was retrospective cohort on CHB patients in CiptoMangunkusumo Hospital, Jakarta who uderwent treatment between January 2012 and December 2014. Patients received oral antiviral treatment with newer nucleoside analogues (entecavir or telbivudine) for at least one year. TE and APRI were obtained before and after treatment. TE and APRI reductions were analyzed statistically with Spearmans test. Results: a total of 41 patients were enrolled in this study. Median liver stiffness value was significantly reduced from 10.8 to 5.9 kPa after oral antiviral treatment (p<0.001, Wilcoxons test). Median APRI was also significantly reduced from 1.13 to 0.43 after treatment (p<0.001, Wilcoxons test). The correlation between liver stiffness and APRI before treatment was weak (r=0.40), but it was strong after treatment (r=0.73). Conclusion: the liver stiffness measured with transient elastography and APRI significantly decreased after one year of antiviral treatment in chronic HBV patients. There was a significant correlation between TE and APRI after one year of treatment.

Abstrak :
Latar Belakang : Karsinoma Sel Hati (KSH) merupakan kanker dengan prognosis yang buruk dan Indonesia termasuk negara dengan prevalensi hepatitis B yang tinggi. Performa alfa fetoprotein (AFP) sebagai penanda tumor pada surveilans KSH terutama dipengaruhi oleh etiologi penyakit hati yang mendasari. Titik potong AFP untuk surveilans KSH di Indonesia tidak berdasarkan etiologi penyakit hati yang mendasari. Tujuan : Mengetahui titik potong terbaik pemeriksaan biomarker AFP untuk surveilans KSH dengan etiologi hepatitis B kronik. Metode : Penelitian mengambil data rekam medis Divisi Hepatobilier RSUPN Dr. Cipto Mangunkusumo periode tahun 2017-2023. Sebanyak 506 subjek hepatitis B kronik semua spekturm (hepatitis B tanpa sirosis, sirosis hati, dan KSH stadium awal BCLC 0 dan A) diambil secara total sampling dalam kurun waktu 26 Juli 2023 hingga 31 Agustus 2023. Penentuan nilai titik potong AFP dilakukan dengan metode receiver operating characteristics (ROC). Hasil : Untuk surveilans KSH dengan etiologi hepatitis B, analisis kurva ROC memberikan area under the curve (AUC) didapatkan 0.792 (IK 95%, 0.719-0.866), dan titik potong dengan index Youden tertinggi adalah 8.7 ng/ml, dengan nilai sensitivitas 58%, spesifisitas 94%, nilai duga positif (NDP) 56.14%, nilai duga negatif (NDN) 94.43%. Analisis kurva ROC dilanjutkan berdasarkan status sirosis pasien. Untuk menentukan titik potong yang membedakan KSH dengan sirosis hati dari sirosis hati saja, menghasilkan AUC 0.803 (IK 95%, 0.722-0.884) dengan titik potong yang didapatkan adalah 8.6 ng/ml, dengan sensitivitas, spesifisitas, NDP, NDN, dan RK + adalah 60.5%, 92.4%, 45,10%, 95,24%, dan 7,09 masing-masing. Untuk menentukan titik potong yang membedakan KSH tanpa sirosis hati dari hepatitis B kronik tanpa sirosis hati, menghasilkan AUC 0.777 (IK 95%, 0.631-0.923) dengan titik potong yang didapatkan adalah 6.6 ng/ml yang memberikan hasil sensitivitas, spesifisitas, NDP, NDN, dan RK positif adalah 63.16%, 98.35%, 85.71%, 94.44%, dan 38.21 masing-masing. Kesimpulan : Titik potong surveilans KSH dengan etiologi spesifik hepatitis B lebih rendah dibandingkan dengan nilai titik potong AFP surveilans KSH sebelumnya yang tidak spesifik etiologi. Nilai titik potong 8.7 ng/ml menghasilkan sensitivitas dan spesifisitas terbaik untuk titik potong surveilans KSH dengan etiologi hepatitis B. Pada pasien KSH non sirosis, titik potong surveilans AFP lebih rendah yakni 6.6 ng/ml. Hal ini perlu menjadi perhatian klinisi dalam surveilans kelompok pasien hepatitis B kronik tanpa sirosis. ......Background: Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis. Indonesia is a country with a high prevalence of chronic hepatitis B infection. The performance of alpha fetoprotein (AFP) as a tumor marker in HCC surveillance is primarily influenced by the etiology of the underlying liver disease. The AFP cutoff value for HCC surveillance in Indonesia is not based on the etiology of the underlying liver disease. Objective: To determine the best cut-off value of AFP biomarker examination for HCC surveillance in chronic hepatitis B patients. Methods: The study took medical record data from the Hepatobiliary Division of RSUPN Dr. Cipto Mangunkusumo for the 2017-2023 period. A total of 506 chronic hepatitis B subjects of all spectrums (hepatitis B without cirrhosis, liver cirrhosis, and early stage HCC, BCLC 0 and A) were taken by total sampling in the period 26 July 2023 to 31 August 2023. Determination of the AFP cut-off value was carried out using the receiver operating characteristics (ROC) method. Results: For HCC surveillance caused by hepatitis B virus, ROC curve analysis gave an area under the curve (AUC) of 0.792 (95% CI, 0.719-0.866), and the cut-off value with the highest Youden index was 8.7 ng/ml, with a sensitivity value of 58%, specificity 94%, positive predictive value (PPV) 56.14%, negative predictive value (NPV) 94.43%. ROC curve analysis was then performed based on the patient's cirrhosis status. ROC curve analysis to determine the cut-off point that distinguishes HCC with liver cirrhosis from liver cirrhosis alone, resulted in an AUC of 0.803 (95% IK, 0.722-0.884) with a cut-off point 8.6 ng/ml, with sensitivity, specificity, PPV, NPV, and LR+ of 60.5%, 92.4%, 45.10%, 95.24%, and 7.09 respectively. ROC curve analysis to determine the cut-off point that distinguishes HCC without liver cirrhosis from chronic hepatitis B without liver cirrhosis resulted in an AUC of 0.777 (95% CI, 0.631-0.923) with a cut-off point 6.6 ng/ml which gave sensitivity, specificity, PPV, NPV, and LR positive results of 63.16%, 98.35%, 85.71%, 94.44%, and 38.21 respectively. Conclusion: The cut-off value of AFP in HCC surveillance on hepatitis B specific etiology is lower than the cut-off value of AFP in previous HCC surveillance which was not etiology specific. The cut-off value of 8.7 ng/ml produces the best sensitivity and specificity for the cut-off value for HCC surveillance with hepatitis B etiology. In non- cirrhotic HCC patients, the AFP surveillance cut-off point is lower than cirrhotic HCC patients (6.6 ng/ml). This needs to be of concern to clinicians in surveillance of groups of chronic hepatitis B patients without cirrhosis.