Fujimori Naoyuki, Tanaka Naoki, Kimura Takefumi, Sano Kenji, Horiuchi Akira, Kato Naoyuki, Takahashi Yoshiyuki, Kuribayashi Naoya, Sugiura Ayumi, Yamazaki Tomoo, Joshita Satoru, Umemura Takeji, Matsumoto Akihiro, Tanaka Eiji
Department of Internal Medicine, Division of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Metabolic Regulation, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan.
Clin J Gastroenterol. 2020 Feb;13(1):83-89. doi: 10.1007/s12328-019-01018-1. Epub 2019 Jul 10.
A 60-year-old Japanese woman was referred to our hospital for further examination of persistent liver dysfunction. She had been suffering from type 2 diabetes mellitus since the age of 50 years. Her hemoglobin A1c (HbA1c) value was as high as 7.8% despite treatment with dipeptidyl peptidase-4 inhibitor, metformin, and sulfonylurea. After excluding viral hepatitis, alcohol or drug-induced liver injury, and autoimmune liver diseases, liver histology evidence of macrovesicular steatosis, hepatocyte ballooning, and pericellular fibrosis confirmed a diagnosis of non-alcoholic steatohepatitis (NASH). Luseogliflozin (2.5 mg/day), a sodium-glucose cotransporter 2 inhibitor (SGLT2I), was co-administered to strengthen glycemic control. Liver enzymes and HbA1c gradually improved without any adverse events. A second liver biopsy at 15 months after luseogliflozin commencement revealed improvements in steatosis, fibrosis, and overall histological activity score. This case demonstrates that long-term luseogliflozin may be a good therapeutic option for diabetic NAFLD/NASH patients. The merits of persistent SGLT2I administration for NAFLD/NASH patients warrant validation in future studies.
一名60岁的日本女性因持续性肝功能不全被转诊至我院进行进一步检查。她自50岁起就患有2型糖尿病。尽管使用了二肽基肽酶-4抑制剂、二甲双胍和磺脲类药物进行治疗，她的糖化血红蛋白（HbA1c）值仍高达7.8%。在排除病毒性肝炎、酒精或药物性肝损伤以及自身免疫性肝病后，肝脏组织学显示大泡性脂肪变性、肝细胞气球样变和细胞周围纤维化，确诊为非酒精性脂肪性肝炎（NASH）。联合使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2I）鲁格列净（2.5毫克/天）以加强血糖控制。肝酶和HbA1c逐渐改善，且未出现任何不良事件。在开始使用鲁格列净15个月后进行的第二次肝脏活检显示，脂肪变性、纤维化和整体组织学活动评分均有所改善。该病例表明，长期使用鲁格列净可能是糖尿病性非酒精性脂肪性肝病/非酒精性脂肪性肝炎患者的良好治疗选择。持续给予SGLT2I对非酒精性脂肪性肝病/非酒精性脂肪性肝炎患者的益处有待未来研究验证。
