Predictive Role of Non-Invasive Laboratory Markers in Hepatic Fibrosis among Hepatitis B Patients
DOI:
https://doi.org/10.33096/gmj.v7i2.222Kata Kunci:
Chronic hepatitis B, Liver fibrosis, Non-invasive biomarkers, GAR, APPR, AGPRAbstrak
Abstrak
Pendahuluan: Hepatitis B kronis (CHB) merupakan penyebab utama fibrosis hati, dimana komplikasi berupa sirosis hepatis sering terjadi pada pasien yang terlambat terdiagnosis. Biomarker noninvasif seperti Gamma-glutamyl Transferase to Albumin Ratio (GAR), Alkaline Phosphatase to Platelet Ratio (APPR), dan Alkaline Phosphatase plus Gamma-glutamyl Transferase to Platelet Ratio (AGPR) memiliki potensi dalam memprediksi tingkat keparahan fibrosis serta menunjukkan akurasi yang lebih baik dibandingkan penanda tradisional seperti APRI.
Metode: Peneliti melakukan penelitian cross sectional terhadap tiga puluh empat pasien CHB di RSUP Dr. Sardjito Yogyakarta pada Oktober 2022 hingga Februari 2023. Liver stiffness diukur menggunakan shear wave elastography (SWE) dan diklasifikasikan berdasarkan sistem Metavir (F0–F4). Peneliti menghitung indeks GAR, APPR, dan AGPR dari data laboratorium. Analisis korelasi Spearman dan regresi linier dilakukan untuk mengevaluasi hubungan ketiga indeks tersebut dengan tingkat keparahan fibrosis.
Hasil: Indeks AGPR menunjukkan korelasi paling kuat dengan stadium fibrosis (ρ = 0,611; p < 0,001), diikuti oleh GAR (ρ = 0,450; p = 0,008) dan APPR (ρ = 0,384; p = 0,026). Ketiga indeks signifikan pada analisis regresi univariat. Model gabungan memberikan kinerja prediktif yang lebih baik dengan nilai R² sebesar 0,389 (p = 0,003) walaupun tidak menunjukkan signifikansi independen pada analisis multivariat.
Kesimpulan: Indeks GAR, APPR, dan AGPR merupakan biomarker noninvasif yang berpotensi untuk menilai tingkat keparahan fibrosis hati pada pasien CHB. Penggunaan ketiga indeks secara bersamaan meningkatkan akurasi diagnostik dan memberikan manfaat praktis pada fasilitas pelayanan kesehatan dengan keterbatasan akses biopsi hati.
Kata kunci: Hepatitis B kronis; Fibrosis hati; Biomarker noninvasif; GAR; APPR; AGPR
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