Noda Sonomi, Harai Nozomi, Komai Saki, Inukai Takahiko, Watanabe Tomomi, Hosokawa Tadatsugu, Antoku Airi, Muroi Yuko, Hayashida Ryosuke, Okuma Hideyuki, Suzuki Yuichiro, Tsuchiya Kyoichiro
Department of Diabetes and Endocrinology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 4093898 Japan.
Department of Gastroenterology Faculty of Medicine, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 4093898 Japan.
Diabetol Int. 2023 Dec 11;15(2):297-301. doi: 10.1007/s13340-023-00675-5. eCollection 2024 Apr.
A 36-year-old woman presented to the emergency room with a consciousness disorder after developing abdominal pain with diarrhea for 2 days. She presented with marked hyperglycemia, ketoacidosis, and increased serum free fatty acid (FFA) levels; however, no elevation in the glycated hemoglobin (HbA1c) levels was observed. Based on the marked depletion of insulin secretion, the patient was diagnosed as diabetic ketoacidosis attributed to fulminant type 1 diabetes (FT1D). Computed tomography on admission revealed severe fatty liver (FL), which improved 17 h following insulin treatment. Insulin treatment also suppressed the serum FFA levels. Some cases of FT1D with FL and liver dysfunction have been reported previously; however, its pathogenesis and clinical course remain unclear. Compared to previous reports, this case reported the shortest time for FL improvement. In this case, rapid and severe insulin deficiency led to a markedly high FFA level and significant accumulation of triglycerides in the hepatocytes, resulting in severe FL. A rapid and large dose of insulin was administered when systemic insulin sensitivity was nearly maximal owing to insulin deficiency, increased insulin efficacy, early reduction of FFA, suppressed triglyceride accumulation in the hepatocytes, and increased triglyceride excretion from the liver. All these factors could have contributed to the rapid improvement in FL.
一名36岁女性在出现腹痛伴腹泻2天后因意识障碍被送往急诊室。她表现为明显的高血糖、酮症酸中毒和血清游离脂肪酸（FFA）水平升高；然而，糖化血红蛋白（HbA1c）水平未见升高。基于胰岛素分泌的显著减少，该患者被诊断为暴发性1型糖尿病（FT1D）所致的糖尿病酮症酸中毒。入院时的计算机断层扫描显示严重脂肪肝（FL），胰岛素治疗17小时后有所改善。胰岛素治疗还降低了血清FFA水平。此前已有一些FT1D合并FL和肝功能障碍的病例报道；然而，其发病机制和临床过程仍不清楚。与之前的报道相比，本病例中FL改善的时间最短。在本病例中，快速而严重的胰岛素缺乏导致FFA水平显著升高以及甘油三酯在肝细胞中大量蓄积，从而导致严重的FL。当由于胰岛素缺乏、胰岛素效能增加、FFA早期降低、肝细胞中甘油三酯蓄积受抑制以及肝脏甘油三酯排泄增加而使全身胰岛素敏感性接近最大时，给予了快速大剂量胰岛素。所有这些因素可能都促成了FL的快速改善。
