Asakawa Masahiro, Takagi Noriko, Hamada Daisuke, Yamasaki Yuko, Katsuta Hidenori
Department of Endocrinology and Metabolism, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo, Japan.
Diabetol Int. 2023 Feb 18;14(3):243-251. doi: 10.1007/s13340-023-00619-z. eCollection 2023 Jul.
Pioglitazone ameliorates liver dysfunction in type 2 diabetes (T2D) patients with non-alcoholic fatty liver disease (NAFLD); however, its efficacy in T2D patients with alcoholic fatty liver disease (AFLD) is unclear. Here, we conducted a retrospective single-center trial investigating whether pioglitazone ameliorates liver dysfunction in T2D patients with AFLD. T2D patients ( = 100) receiving 3 months of additional pioglitazone were divided into those with or without fatty liver (FL), and those with FL were further classified into AFLD ( = 21) and NAFLD ( = 57) groups. The effects of pioglitazone were compared across groups using medical record data on body weight changes; HbA1c, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase (γ-GTP) levels; and fibrosis-4 (FIB-4) index. The pioglitazone dose (mean dose: 10.6 ± 4.6 mg/day) did not affect weight gain but significantly decreased the HbA1c level in patients with or without FL ( < 0.01 and < 0.05, respectively). The decrease in HbA1c level was significantly more pronounced in patients with FL than in those without FL ( < 0.05). In patients with FL, the HbA1c, AST, ALT, and γ-GTP levels significantly decreased after pioglitazone treatment than before ( < 0.01). The AST and ALT levels, but not the γ-GTP level, and the FIB-4 index significantly decreased after pioglitazone addition in the AFLD group, similar to that in the NAFLD group ( < 0.05 and < 0.01, respectively). Similar effects were observed following low-dose pioglitazone treatment (≤ 7.5 mg/day) ( < 0.05) in T2D patients with AFLD and NAFLD. These results suggest that pioglitazone may be also an effective treatment option for T2D patients with AFLD.
吡格列酮可改善患有非酒精性脂肪性肝病（NAFLD）的2型糖尿病（T2D）患者的肝功能障碍；然而，其对患有酒精性脂肪性肝病（AFLD）的T2D患者的疗效尚不清楚。在此，我们进行了一项回顾性单中心试验，以研究吡格列酮是否能改善患有AFLD的T2D患者的肝功能障碍。接受额外3个月吡格列酮治疗的T2D患者（n = 100）被分为有或没有脂肪肝（FL）的患者，而有FL的患者进一步分为AFLD组（n = 21）和NAFLD组（n = 57）。使用关于体重变化、糖化血红蛋白（HbA1c）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和γ-谷氨酰转肽酶（γ-GTP）水平以及纤维化-4（FIB-4）指数的病历数据比较各组间吡格列酮的效果。吡格列酮剂量（平均剂量：10.6±4.6毫克/天）不影响体重增加，但显著降低了有或没有FL的患者的HbA1c水平（分别为P<0.01和P<0.05）。HbA1c水平的降低在有FL的患者中比在没有FL的患者中更显著（P<0.05）。在有FL的患者中，吡格列酮治疗后HbA1c、AST、ALT和γ-GTP水平显著低于治疗前（P<0.01）。在AFLD组中，添加吡格列酮后AST和ALT水平显著降低，但γ-GTP水平未降低，FIB-4指数也显著降低，与NAFLD组相似（分别为P<0.05和P<0.01）。在患有AFLD和NAFLD的T2D患者中，低剂量吡格列酮治疗（≤7.5毫克/天）后也观察到类似效果（P<0.05）。这些结果表明，吡格列酮可能也是患有AFLD的T2D患者的一种有效治疗选择。
