PENYAKIT PERLEMAKAN HATI NON ALKOHOLIK PADA ANAK

Abstract

Abstrak
Penyakit perlemakan hati nonalkoholik (NAFLD) ditandai dengan penumpukan lemak di hati pada penderita yang tidak mengkonsumsi alkohol sebelumnya, meliputi steatosis sederhana dan steatohepatitis nonalkoholik (NASH). NAFLD/NASH merupakan manifestasi hepatik dari sindrom metabolik. Prevalensi NAFLD pada anak mengalami peningkatan seiring dengan meningkatnya prevalensi obesitas pada anak. Kelainan ini berhubungan dengan umur, jenis kelamin dan ras. Patogenesisnya diterangkan melalui hipotesis “dua pukulan”. Selain manifestasi klinis, laboratorium dan pencitraan, biopsi hati merupakan baku emas dalam menegakkan diagnosis. Melalui biopsi hati dapat dinilai derajat nekroinflamatori yang terjadi serta fibrosis pada NASH. Terdapat 2 jenis steatohepatitis dengan tipe 2 ditemukan pada 51% penderita NAFLD anak. Walaupun telah dilakukan uji klinis terhadap beberapa obat, namun modifikasi gaya hidup, pola makan dan kebiasaan berolahraga merupakan tatalaksana yang banyak diterapkan saat ini.
Kata kunci : penyakit perlemakan hati nonalkoholik, steatohepatits nonalkoholik, obesitas
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a disease in which excessive fat accumulates in the liver without a history of alcohol abuse. This disease includes simple steatosis and nonalcoholic steatohepatitis (NASH). NAFLD/NASH is recognized as a hepatic manifestation of metabolic syndrome. In recent years, pediatric NAFLD has increased in line with the increased prevalence of pediatric obesity. It is associated with sex, age and ethnicity. The “two-hit” hypothesis is widely accepted as the pathogenesis. Although clinical symptoms, laboratory data and imaging findings are important, liver biopsy is regarded as the gold standard of the diagnosis. It is essential for assessing the degree of necro-inflammatory change and fibrosis in NASH. Two different types of steatohepatitis have been reported, with type 2 NASH being present in as many as 51% of pediatric NAFLD patients. Although pharmacotherapy has been studied in clinical trials, lifestyle modification by diet and exercise remains the mainstay of treatment for NAFLD/NASH.
Key word : nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, obesity