King R J, Harrison L, Gilbey S G, Santhakumar A, Wyatt J, Jones R, Bodansky H J
Department of Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK.
Department of Hepatology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK.
Diabet Med. 2016 Feb;33(2):e5-7. doi: 10.1111/dme.12898.
Liver disease in diabetes is common and is frequently the result of hepatic steatosis. Diabetic hepatosclerosis is a relatively recent description of sinusoidal fibrosis, without steatosis, observed in liver biopsies of people with diabetes presenting with cholestasis. Its association with other microvascular complications suggests it is a form of hepatic diabetic microangiopathy.
We report the case of a 50-year-old woman with longstanding Type 1 diabetes, complicated by nephropathy resulting in cadaveric renal transplant, retinopathy, gastroparesis and neuropathy with slowly healing ulceration to her right foot. She was noted to have deranged liver function tests: alanine aminotransferase, 162 IU/l; bilirubin, 44 IU/l; alkaline phosphatase, 5279 IU/l (isoenzymes; bone 1029 IU/l, liver 4250 IU/l); γ-glutamyl transferase, 662 IU/l. A non-invasive liver screen did not reveal the cause of the cholestasis. A liver biopsy demonstrated sinusoidal fibrosis without evidence of steatosis and thus a diagnosis of diabetic hepatosclerosis was made. Comparison with a biopsy performed 11 years previously at a different trust due to elevated alkaline phosphatase levels revealed slow progression of the sinusoidal fibrosis.
This case describes the longest reported clinical course of diabetic hepatosclerosis, spanning 11 years, in which time the patient did not develop evidence of cirrhosis or portal hypertension. It is difficult to estimate the clinical relevance of this condition because little is known regarding its clinical course and effect on morbidity and mortality. Identified patients should undergo low-intensity, long-term follow-up to improve understanding of its clinical sequelae and relevance.
糖尿病患者的肝脏疾病很常见，通常是肝脂肪变性的结果。糖尿病性肝硬变是对在出现胆汁淤积的糖尿病患者肝活检中观察到的无脂肪变性的窦性纤维化的一种相对较新的描述。它与其他微血管并发症的关联表明它是肝糖尿病微血管病变的一种形式。
我们报告一例50岁女性，患有长期1型糖尿病，并发肾病，接受了尸体肾移植，还有视网膜病变、胃轻瘫和神经病变，右脚溃疡愈合缓慢。她的肝功能检查结果异常：丙氨酸转氨酶162 IU/L；胆红素44 IU/L；碱性磷酸酶5279 IU/L（同工酶；骨同工酶1029 IU/L，肝同工酶4250 IU/L）；γ-谷氨酰转移酶662 IU/L。非侵入性肝脏检查未发现胆汁淤积的原因。肝脏活检显示窦性纤维化，无脂肪变性证据，因此诊断为糖尿病性肝硬变。与11年前因碱性磷酸酶水平升高在另一家医院进行的活检相比，发现窦性纤维化进展缓慢。
本病例描述了糖尿病性肝硬变最长的临床病程，长达11年，在此期间患者未出现肝硬化或门静脉高压的证据。由于对这种疾病的临床病程及其对发病率和死亡率的影响知之甚少，因此很难估计其临床相关性。确诊患者应接受低强度、长期随访，以增进对其临床后遗症和相关性的了解。
