Electronic Theses and Dissertation

Latar Belakang: Endometriosis adalah penyakit inflamasi kronik yang estrogen-dependent dengan prevalensi mencapai 10% pada wanita usia subur dan 50% pada wanita infertil. Proses inflamasi ini meningkatkan jumlah makrofag aktif yang mensekresikan sitokin pro-inflamasi seperti tumour necrosis factor-α (TNF-α), dan Cancer Antigen 125 (CA-125) yang telah lama digunakan sebagai biomarker untuk evaluasi tumor pelvic. Mengingat diagnosis baku emas laparoskopi bersifat invasif, diperlukan identifikasi biomarker non-invasif yang dapat memprediksi derajat keparahan dan intensitas nyeri.
Tujuan: Menganalisis korelasi kadar TNF-α cairan peritoneal dan CA-125 serum terhadap derajat endometriosis berdasarkan klasifikasi revised American Society for Reproductive Medicine classification (rASRM) serta derajat nyeri menggunakan Numeric Rating Scale (NRS) pada pasien endometriosis.
Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain cross-sectional. Sampel penelitian berjumlah 47 subjek yang terdiagnosa endometriosis dan menjalani operasi di RSUD Dr. Zainoel Abidin Banda Aceh pada periode tertentu. Kadar TNF-α diukur dari cairan peritoneal menggunakan metode (Enzyme-Linked Immunosorbent Assay )ELISA, sedangkan kadar CA-125 diukur dari serum darah melalui metode chemiluminescence immunoassay (CLIA). Analisis data dilakukan secara univariat, bivariat (uji korelasi Spearman/Pearson), dan multivariat (uji regresi ordinal).
Hasil: Hasil analisis menunjukkan bahwa secara bivariat, kadar TNF-α tidak memiliki korelasi signifikan dengan derajat endometriosis (p=0,649) namun berkorelasi positif signifikan dengan derajat nyeri (p=0,020; r=0,338). Kadar CA-125 memiliki korelasi positif signifikan terhadap derajat endometriosis (p=0,005; r=0,401) maupun derajat nyeri (p=0,018; r=0,344). Analisis multivariat secara simultan menunjukkan kedua biomarker berpengaruh signifikan terhadap derajat endometriosis (p=0,018) dan derajat nyeri (p=0,008). Secara parsial, CA-125 ditemukan lebih dominan mempengaruhi derajat endometriosis, sedangkan TNF-α lebih dominan mempengaruhi derajat nyeri.
Kesimpulan: Kadar CA-125 serum lebih berperan dalam menilai aspek anatomis (derajat keparahan penyakit), sementara kadar TNF-α cairan peritoneal lebih berperan dalam menilai aspek fungsional (derajat nyeri) pada pasien endometriosis. Kombinasi kedua biomarker ini dapat digunakan sebagai modalitas diagnostik tambahan yang lebih komprehensif untuk stratifikasi risiko dan perencanaan tatalaksana pasien sebelum tindakan operatif.
Kata Kunci: Endometriosis, TNF-α, CA-125, Derajat Nyeri, Derajat Endometriosis

Background: Endometriosis is a chronic, estrogen-dependent inflammatory disease with a prevalence of up to 10% in women of childbearing age and 50% in infertile women. This inflammatory process increases the number of activated macrophages that secrete pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α) and Cancer Antigen 125 (CA-125), which have long been used as biomarkers for pelvic tumor evaluation. Given the invasive nature of laparoscopy as the gold standard for diagnosis, it is necessary to identify non-invasive biomarkers that can predict pain severity and intensity. Objective: To analyze the correlation between peritoneal fluid TNF-α and serum CA-125 levels with the degree of endometriosis based on the revised American Society for Reproductive Medicine classification (rASRM) and the degree of pain using the Numeric Rating Scale (NRS) in endometriosis patients. Methods: This study was an observational analytical study with a cross-sectional design. The sample consisted of 47 subjects diagnosed with endometriosis and undergoing surgery at Dr. Zainoel Abidin Regional General Hospital, Banda Aceh, during a specific period. TNF-α levels were measured from peritoneal fluid using the Enzyme-Linked Immunosorbent Assay (ELISA) method, while CA-125 levels were measured from blood serum using the chemiluminescence immunoassay method (CLIA). Data analysis was performed using univariate, bivariate (Spearman/Pearson correlation test), and multivariate (ordinal regression test). Results: Bivariate analysis showed that peritoneal TNF-α levels had no significant correlation with endometriosis stages (p=0.649) but showed a significant positive correlation with pain levels (p=0.020; r=0.338). Conversely, CA-125 levels correlated significantly and positively with both endometriosis stages (p=0.005; r=0.401) and pain levels (p=0.018; r=0.344). Simultaneous multivariate analysis indicated that both biomarkers significantly influenced endometriosis stages (p=0.018) and pain levels (p=0.008). Partially, CA-125 was more dominant in influencing endometriosis stages, while TNF-α was more dominant in influencing pain levels. Conclusion: Serum CA-125 levels are more effective in assessing anatomical aspects (disease severity), while peritoneal fluid TNF-α levels are more effective in assessing functional aspects (pain levels) in endometriosis patients. The combination of these two biomarkers can serve as a more comprehensive additional diagnostic modality for risk stratification and treatment planning prior to surgical intervention. Keywords: Endometriosis, TNF-α, CA-125, Pain Intensity, degree of endometriosis.