Yamashima Mio, Miyaaki Hisamitsu, Miuma Satoshi, Shibata Hidetaka, Sasaki Ryu, Haraguchi Masafumi, Fukushima Masanori, Nakao Kazuhiko
Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Japan.
Intern Med. 2019;58(14):1987-1992. doi: 10.2169/internalmedicine.2566-18. Epub 2019 Jul 15.
Objective Sodium glucose co-transporter 2 inhibitor (SGLT-2i), recommended for patients with type 2 diabetes, has been reported to improve the liver function test results in non-alcoholic fatty liver disease (NAFLD). However, the long-term effects of SGLT-2i on the liver function and body weight in NAFLD patients have not been fully elucidated. In this study, we investigated the long-term effects of SGLT-2i in NAFLD patients. Methods Twenty-two diabetic patients with NAFLD were enrolled in this study. We assessed the body weight, liver enzyme levels, metabolism, and glucose levels at 12 months (22 cases) and 24 months (15 cases) after the initiation of SGLT-2i. The changes in controlled attenuation parameter (CAP) and liver stiffness in 20 of the 22 patients were evaluated using transient elastography (TE) and acoustic radiation force impulse (ARFI) elastography before the initiation of treatment and 1 year later. Results Body weight and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly decreased at 12 and 24 months after SGLT-2i treatment. The decrease in the levels of ALT at 12 and 24 months was significantly correlated with the level of ALT at the initiation of SGLT-2i (r=0.813, p=0.001 and r=0.867, p=0.0001, respectively). SGLT-2i also reduced the CAP and velocity of shear wave (Vs) values at 12 months (CAP 315.1±43.4 db/mL→293.1±27.2 db/mL, p=0.027; Vs 1.87±0.8 m/s→ 1.48±0.6 m/s, p=0.011). Conclusion SGLT-2i treatment improved the liver function test results and reduced the body weight in NAFLD patients over a period of 12-24 months. This improvement was greater in patients with higher ALT values at baseline than in those with lower values.
目的 钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）被推荐用于2型糖尿病患者，据报道其可改善非酒精性脂肪性肝病（NAFLD）患者的肝功能检查结果。然而，SGLT-2i对NAFLD患者肝功能和体重的长期影响尚未完全阐明。在本研究中，我们调查了SGLT-2i对NAFLD患者的长期影响。方法 22例患有NAFLD的糖尿病患者纳入本研究。我们在开始使用SGLT-2i后的12个月（22例）和24个月（15例）评估体重、肝酶水平、代谢和血糖水平。在22例患者中的20例中，使用瞬时弹性成像（TE）和声辐射力脉冲（ARFI）弹性成像在治疗开始前和1年后评估受控衰减参数（CAP）和肝脏硬度的变化。结果 在SGLT-2i治疗后的12个月和24个月，体重以及天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平显著降低。12个月和24个月时ALT水平的降低与开始使用SGLT-2i时的ALT水平显著相关（分别为r=0.813，p=0.001和r=0.867，p=0.0001）。SGLT-2i在12个月时也降低了CAP和剪切波速度（Vs）值（CAP 315.1±43.4 db/mL→293.1±27.2 db/mL，p=0.027；Vs 1.87±0.8 m/s→1.48±0.6 m/s，p=0.011）。结论 SGLT-2i治疗在12至24个月期间改善了NAFLD患者的肝功能检查结果并减轻了体重。基线ALT值较高的患者比ALT值较低的患者改善更大。
