Perlemakan hati non alkoholik

Article Sidebar

PDF
Published: Dec 27, 2007
DOI: https://doi.org/10.18051/UnivMed.2007.v26.205-215 Universa Medicina
Abstract Viewed: 2032
PDF Downloaded: 640
Keywords:
Perlemakan hati obesitas abdominal diabetes tipe 2

Main Article Content

A Nurman
Bagian Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Trisakti

Abstract

Spektrum patologi klinik dari perlemakan hati non alkoholik (PHNA) terentang dari simple steatosis sampai non alkoholic steatohepatitis (NASH). Simple steatosis memiliki perjalanan klinik yang relatif jinak, namun NASH dapat berkembang ke sirosis dan karsinoma hepatoseluler. PHNA umumnya asimtomatik dan harus dicurigai pada pasien-pasien dengan obesitas abdominal dan diabetes melitus tipe 2. Peningkatan alanine aminotransferase (ALT) serum dan/atau gambaran perlemakan hati pada USG sering kali merupakan temuan pertama yang mengarahkan diagnosis ke PHNA. Diagnosis PHNA ditegakkan setelah menyingkirkan penyakit hati kronis yang lain; diagnosis definitif hanya dibuat dengan biopsi. Peningkatan ALT umumnya tidak melebihi 5 kali batas atas nilai normal. Adanya ikterus, bilirubinuria dan demam juga menyingkirkan diagnosis PHNA. Sebagian besar steatosis hepatik tidak berkembang menjadi fibrosis atau steato hepatitis, 30-40% akan menjadi fibrosis dalam periode 4 tahun dan +15% akan berkembang menjadi sirosis. Penatalaksanaan PHNA tidak ditargetkan pada hepar saja, melainkan harus holistik, berpusat pada perbaikan resistensi insulin dan gangguan metabolisme terkait, yang dimulai dengan modifikasi gaya hidup. Berat badan harus diturunkan secara bertahap.Vitamin E dan asam ursodeoksikolat diberikan karena dapat menurunkan ALT. Metformin dan/atau rosiglitazone dapat diberikan pada pasien tanpa diabetes yang nyata, karena obat-obat ini tidak menyebabkan hipoglikemia, dan dapat meningkatkan sensitivitas insulin. Perburukan fungsi hati juga harus dicegah dengan menghindari zat-zat hepatotoksik.

Article Details

How to Cite
Nurman, A. (2007). Perlemakan hati non alkoholik. Universa Medicina, 26(4), 205–215. https://doi.org/10.18051/UnivMed.2007.v26.205-215
Issue
Vol. 26 No. 4 (2007)
Section
Review Article

The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.

References

Marchesini G, Brizi M, Morselli-Labate AM, Bianchi G, Bugianesi E, McCullough, et al. Association of nonalcoholic fatty Liver disease with insulin resistance. Am J Med 1999;107:450-5.

Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Tani S, Goto M, et al. Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med 1988; 27: 142-9.

Bellentani S, Tiribelli C, Saccoccio G, Sodde M, Fratti N, De Martin C, et al. Prevalence of chronic liver disease in the general population of Northern Italy: the dionysos study. Hepatology 1994; 20: 1442-9.

Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 2003; 98: 960-7.

Marchesini G, Brizi M, Binchi G, Tomsseti S, Bugianesi E, Lensi M, et al. Nonalcoholic fatty liver disease: a feature of metabolic syndrome. Diabetes 2001; 50: 1844-50.

Pendino GM, Mariano A, Surace P, Caserta CA, Fiorillo MT, Amante A, et al. Prevalence and etiology of altered liver tests: a population-based survey in a Mediterranean Town. Hepatology 2005; 41: 1151-9.

Hasan I, Lesmana LR, Gani RA, Machmud R, Akbar N, Noer HMS, et al. Prevalance and risk factors for non alcoholic fatty liver in Indonesia. PIN XIV PPHI, Konas XIII PGI-PEGI, Surabaya 2007.

Marceau P, Biron F, Hould FS, Mrceau S, Simard S, Thung SN, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab 1999; 84: 1513-7.

Hanley AJ, Williams K, Festa A, Wagenknecht LE, D’Agostino RB Jr, Kempf J. Elevations in markers of liver injury and risk of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes 2004; 53: 2623-32.

Portincasa P, Grattagliano I, Palmieri VO, Palasciano G. The emerging problem of nonalcoholic steatohepatitis (NASH). Rom J Gastroenterol 2005; 14: 43-51.

Medina J, Fernandez-Salazar LI, Garcia-Buey L, Moreno-Otero R. Approach to the pathogenesis and treatment of nonalcoholic steatohepatitis. Diabetes Care 2004; 27: 2057-66.

Trujillo MF, Scherer PE. Adiponectin. Journey from Care 2004; 27: 2057-66.

Wigg AJ, Roberts-Thomson I, Dymock RB, McCarthy PJ, Grose RH, Cummins AG. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia and tumor necrosis factor-alpha in the pathogenesis of nonalcoholic steatohepatitis. Gut 2001; 48: 206-11.

Mofrad PS, Sanyal AJ. Gastroenterology expert column: nonalcoholic fatty liver disease. Gen Med 2003; 5: 2.

Choudhury J, Sanyai A. Clinical aspects of fatty liver disease. Semin Liver Dis 2004; 24: 349-62.

Limanond P, Raman SS, Lassman C, Sayre J, Ghobrial RM, Buuttil RW, et al. Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology 2004; 230: 276-80.

Fishbein M, Castro F, Cheruku S, Jain S, Webb B, Gleason T, et al. Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol 2005; 39: 619-25.

Longo R, Pollesello P, Ricci C, Masutti F, Kvam BJ, Bercich L, et al. Proton MR spectroscopy in quantitative in vivo determination of fat content in human liver steatosis. J Magn Reson Imaging 1995; 5: 281-5.

Moriyasu F, Iijima H, Tsuchiya K, Miyata Y, Furusaka A, Miyahara T. Diagnosis of NASH using delayed parenchymal imaging of contrast ultrasound. Hepatol Res 2005; 33: 97-9.

Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, et al. Noninvesive assesment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005; 41: 48-54.

Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Nonalcoholic steatohepatitis clinical research network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41: 1313-21.

Ratzui V. Sampling variability of liver biopsy ini nonalcoholic fatty liver disease. Gastroenterology 2005; 128: 1898-906.

Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986; 2: 165-73.

Ratziu V, Massard J, Charlotte F, Messous D, Imbert-Bismut F, Bonyhay L, et al. Diagnostic value of biochemical markers (Fibro Test-FibroSURE) for the prediction of liver fibrosis in patients with non alcoholic fatty liver disease. BMC Gatroenterol 2006; 6: 6.

Bugianesi E, Pagotto U, Manini R, Vanni E, Gastaldelli A, de Iasio R, et al. Plasma adiponectin in nonalcoholic fatty liver is related to hepatic insulin resistance and hepatic fat content, not to liver disease severity. J Clin Endocrinol Metab 2005; 90: 3498-504.

Hui J M. Beyond insulin resistance in NASH: TNH – alpha or adiponectin? Hepatology 2004; 40: 46-54.

Angulo P. Leptin, insulin resistance, and liver fibrosis in human nonalcoholic fatty liver disease. J Hepatol 2004; 41: 943-9.

Angulo P, Lindor KD. Treatment of nonalcoholic fatty liver: present and emerging therapies. Semin Liver Dis 2001; 21: 81-8.

Bugianesi E, Marzocchi R, Villanova N, Marchesini G. Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis: treatment. Best Pract Res Clin Gastroenterol 2004; 18: 1105-16.

Hasegawa T, Yoneda M, Nakamura K, Makino I, Terano A. Plasma transforming growth factor â1 level and efficacy of á-tocopherol in patients with nonalcoholic steatohepatitis: a pilot study. Aliment Pharmacol Ther 2001; 15: 1667-72.

Lavine J. Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study. J Pediatr 2000; 136: 734-8.

Lindor KD, Kowdley KV, Heathcote EJ, Harrison ME, Jorgensen R, Angulo P, et al. Ursodeoxycholic acid for treatment of nonalcoholic steatohepatitis: results of a randomized trial. Hepatology 2004; 39: 770-8.

Laurin J, Lindor K, Crippin JS, Gossard A, Gores GJ, Ludwig J, et al. Ursodeoxycholic acid or clofibrate in the treatment of nonalcohol-induced steatohepatitis: a pilot study. Hepatology 1996; 23: 1464-7.

Bugianesi E, Gentilcore E, Manini R, Natale S, Vanni Em Villanova N, et al. A randomized controlled trial of metformin versus vitamin E or prescriptive diet in nonalcoholic fatty liver disease. Am J Gastroenterol 2005; 100: 1082-90.

Tiikainen M, Hakkinen AM, Korheninnikova E, Nyman T, Makimattila S, Yki-Jarvinen H. Effects of rosiglitazone and metformin on liver fat content, hepatic insulin resistance, insulin clearance, and gene expression in adipose tissue in patients with type 2 diabetes. Diabetes 2004; 53: 2169-76.

Filippatos TD, Kiortsis DN, Liberopoulos EN, Mikhailidis DP, Elisaf MS. A review of the metabolic effects of sibutramine. Curr Med Res Opin 2005; 21: 457-68.

Yokohama S, Yoneda M, Haneda M, Okamoto S, Okada M, Aso K, et al. Therapeutic efficacy of an angiotensin II receptor antagonist in patients with nonalcoholic steatohepatitis. Hepatol 2004; 40: 1222-5.

Hickman IJ, Jonsson JR, Prins JB, Ash S, Purdie DM, Clouston AD, et al. Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in ALT, fasting insulin and quality of life. Gut 2004; 53: 413-9.

Hickman IJ, Clouston AD, Macdonald GA, Purdie DM, Prins JB, Ash S, et al. Effect of weight reduction on liver histology and biochemistry in patients with chronic hepatitis C. Gut 2002; 51: 89-94.

Campbell MS, Reddy KR. The evolving role of liver biopsy. Aliment Pharmacol Ther 2004; 20: 249-59.