Nagai Kazuki, Matsumaru Katsuhiko, Takahashi Yutaka, Nakamura Noriko
Nagai Clinic, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan.
Case Rep Gastroenterol. 2011 May;5(2):336-43. doi: 10.1159/000329346. Epub 2011 Jun 10.
A 56-year-old Japanese female with a 10-year history of thyroiditis presented to our institution. The laboratory data and clinical findings suggested that the patient had complicated nonalcoholic fatty liver disease or nonalcoholic steatohepatitis (NASH) with autoimmune hepatitis according to the criteria by the application of the International Autoimmune Hepatitis score. The patient could not manage by herself so dietary- and exercise-based treatment was difficult. Accordingly, ursodeoxycholic acid and ezetimibe therapy was started and continued until the performance of a liver needle biopsy to define the diagnosis. However, no improvement in liver function was observed. In addition, pathological findings indicated that the patient had NASH. The patient was finally diagnosed as having NASH. Therefore, voglibose was added to the ursodeoxycholic acid and ezetimibe therapy, and this addition of voglibose actually took effect. The patient's serum aspartate transaminase and alanine aminotransferase levels decreased dramatically. This report is the first to document other treatment possibilities of NASH in a case when dietary therapy is difficult.
一名患有10年甲状腺炎病史的56岁日本女性前来我院就诊。实验室数据和临床检查结果表明，根据国际自身免疫性肝炎评分标准，该患者并发了非酒精性脂肪性肝病或非酒精性脂肪性肝炎（NASH）以及自身免疫性肝炎。患者无法自理，因此难以进行基于饮食和运动的治疗。于是，开始使用熊去氧胆酸和依泽替米贝进行治疗，并持续用药直至进行肝穿刺活检以明确诊断。然而，肝功能并未见改善。此外，病理检查结果显示该患者患有NASH。该患者最终被诊断为NASH。因此，在熊去氧胆酸和依泽替米贝治疗的基础上加用了伏格列波糖，而这一添加确实起到了作用。患者的血清天冬氨酸转氨酶和丙氨酸转氨酶水平大幅下降。本报告首次记录了在饮食治疗困难的情况下NASH的其他治疗可能性。
