Nagayama Koji, Harada Risako, Ajima Hiroshi, Orikasa Sakurako, Aoshima Misaki, Oki Yutaka
Endocrinol Diabetes Metab Case Rep. 2025 Jul 24;2025(3). doi: 10.1530/EDM-25-0015. Print 2025 Jul 1.
We used the sodium-glucose cotransporter 2 inhibitor, luseogliflozin in two patients with diabetes mellitus with Child-Pugh classification B cirrhosis and cirrhotic ascites. In each case, luseogliflozin was safely used for over three years and was also considered effective in reducing ascites. In one of the patients in particular, when luseogliflozin was discontinued and switched to insulin treatment before colorectal cancer surgery, ascites accumulation was observed within two weeks, which subsequently decreased rapidly when luseogliflozin was restarted. In this case, the effect of luseogliflozin on ascites was evident by the clear increase and decrease in ascites over a short period of time, as evaluated using body weight, abdominal circumference and CT scan, without changing her other diuretic medication. Although sodium-glucose cotransporter 2 inhibitors need to be used with caution, they might be an option for the treatment of diabetes in patients with cirrhosis.
Luseogliflozin, a sodium-glucose cotransporter 2 inhibitor, is effective for glycemic control and safe in patients with cirrhosis. Luseogliflozin administration reduced ascites in patients with diabetes mellitus. Caution is warranted, as discontinuation of sodium-glucose cotransporter 2 inhibitors might lead to an increase in ascites.
我们对两名患有Child-Pugh B级肝硬化和肝硬化腹水的糖尿病患者使用了钠-葡萄糖协同转运蛋白2抑制剂鲁格列净。在每例患者中，鲁格列净均安全使用超过三年，且在减少腹水方面也被认为是有效的。特别是其中一名患者，在结直肠癌手术前停用鲁格列净并改用胰岛素治疗时，两周内观察到腹水积聚，而重新开始使用鲁格列净后腹水迅速减少。在该病例中，通过体重、腹围和CT扫描评估，鲁格列净对腹水的影响在短时间内腹水明显增减中得以体现，且未改变其其他利尿剂用药。尽管钠-葡萄糖协同转运蛋白2抑制剂需谨慎使用，但它们可能是肝硬化患者糖尿病治疗的一种选择。
钠-葡萄糖协同转运蛋白2抑制剂鲁格列净对血糖控制有效且在肝硬化患者中安全。鲁格列净给药可减少糖尿病患者的腹水。需谨慎，因为停用钠-葡萄糖协同转运蛋白2抑制剂可能导致腹水增加。
