Type 1 Diabetic Patient with Subacute Hepatic Dysfunction during Voglibose and Epalrestat Administration.

概要

論文の詳細を見る
We treated a type 1 diabetic suffering from subacute hepatic dysfunction.After recovery, laparoscopic liver biopsy was conducted for histological evaluation. The patient was 27 years old woman and worked in an office. She suffered diabetic ketoacidosis at the age of 24, and since then she was treated with multiple insulin injection therapy. On April 20, 1998, about 11 months after administration of voglibose (0.6 mg/day) and 3 months of epalrestat (150 mg/day), her GPT and GOT markedly increased (GPT: 880IU/l, GOT: 484IU/l).To evaluate hepatic injury, she was hospitalized on April 27. Viral, autoimmune and alcoholic hepatic injury were excluded by clinical data. After 5 weeks of hospitalization, her coagulation tests worsened: PT: 40.1%, HPT: 31.9%, and serum bilirubin concentration became 3.1 mg/dl. To treat hepatic dysfunction, high-dose continuous PGE 1 infusion therapy (PGE 1 therapy) was started in addition to glucagon-insulin (GI) therapy. After 4 weeks of treatment, her liver function and coagulation tests gradually improved and normalized 4 months later. After recovery in coagulation tests, laparoscopic liver biopsy was conducted, showing profound hepatocellular necrosis, with slight hepatic fibrosis and focal inflammatory changes found by histological examination. Due to negative DLST for both drugs, the clinical cause her liver dysfunction remained unclear.
一般社団法人日本糖尿病学会の論文