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Case Report of a Patient Diagnosed with Fatty Liver Accompanied by Hypertriglyceridemia

고중성지방혈증을 동반한 지방간 환자 치험 1례

  • Hur, Soyoung (Dept. of Internal Medicine, College of Korean Medicine, Kyung Hee University) ;
  • An, Soyeon (Dept. of Internal Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Kim, Eujin (Dept. of Internal Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Hwang, Cho-Hyun (Dept. of Internal Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Jang, Eungyeong (Dept. of Internal Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Kim, Youngchul (Dept. of Internal Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Lee, Jang-Hoon (Dept. of Internal Medicine, College of Korean Medicine, Kyung Hee University)
  • 허소영 (경희대학교 한의과대학 간계내과학교실) ;
  • 안소연 (경희대학교 한의과대학 간계내과학교실) ;
  • 김어진 (경희대학교 한의과대학 간계내과학교실) ;
  • 황조현 (경희대학교 한의과대학 간계내과학교실) ;
  • 장은경 (경희대학교 한의과대학 간계내과학교실) ;
  • 김영철 (경희대학교 한의과대학 간계내과학교실) ;
  • 이장훈 (경희대학교 한의과대학 간계내과학교실)
  • Received : 2021.04.07
  • Accepted : 2021.05.27
  • Published : 2021.05.30

Abstract

Objectives: This study aimed to identify whether herbal medicine improves the clinical symptoms and abnormal blood tests of a patient with fatty liver accompanied by hypertriglyceridemia. Methods: A 44-year-old man with fatty liver and hypertriglyceridemia was prescribed Saenggangunbi-tang from July 20, 2020, to November 11, 2020, to reduce fatigue and to improve laboratory findings, such as liver enzymes and the lipid profile. We observed changes in symptoms, serum levels of liver enzymes, and the lipid profile during about 4-month treatment. We also recorded changes in the bioelectrical impedance analyzer findings during that time. Results: In this case study, an approximately 4-month treatment with Saenggangunbi-tang led to considerable improvement in laboratory findings and visceral fat area. In particular, the patient experienced a noticeable decrease in triglyceride levels compared with the baseline parameters of the first visit. In addition, no side effects-including weight gain and liver enzyme increases-were observed during treatment. Conclusion: This study suggests that appropriately prescribed herbal medicine is a therapeutic option to manage fatty liver combined with hypertriglyceridemia.

Keywords

References

  1. European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol 2012;57(2):399-420. https://doi.org/10.1016/j.jhep.2012.04.004
  2. Machado MV, Diehl AM. Zakim and Boyer's Hepatology, 7th. Vol 25. Philadelphia: Elsevier; 2018, p. 369-39.
  3. Yoon SK. Diagnosis and treatment of fatty liver. Korean J Med 2009;76(6):677-9.
  4. den Boer M, Voshol PJ, Kuipers F, Havekes LM, Romijn JA. Hepatic steatosis: a mediator of the metabolic syndrome. Lessons from animal models. Arterioscler Thromb Vasc Biol 2004;24(4):644-9. https://doi.org/10.1161/01.ATV.0000116217.57583.6e
  5. Tomizawa M, Kawanabe Y, Shinozaki F, Sato S, Motoyoshi Y, Sugiyama T, et al. Triglyceride is strongly associated with nonalcoholic fatty liver disease among markers of hyperlipidemia and diabetes. Biomed Rep 2014;2(5):633-6. https://doi.org/10.3892/br.2014.309
  6. Han JM, Kim HI, Lee YJ, Lee JW, Kim KM, Bae JC. Differing Associations between Fatty Liver and Dyslipidemia According to the Degree of Hepatic Steatosis in Korea. J Lipid Atheroscler 2019;8(2):258-66. https://doi.org/10.12997/jla.2019.8.2.258
  7. Loria P, Marchesini G, Nascimbeni F, Ballestri S, Maurantonio M, Carubbi F, et al. Cardiovascular risk, lipidemic phenotype and steatosis. A comparative analysis of cirrhotic and non-cirrhotic liver disease due to varying etiology. Atherosclerosis 2014;232(1):99-109. https://doi.org/10.1016/j.atherosclerosis.2013.10.030
  8. Boullart AC, de Graaf J, Stalenhoef AF. Serum triglycerides and risk of cardiovascular disease. Biochim Biophys Acta 2012;1821(5):867-75. https://doi.org/10.1016/j.bbalip.2011.10.002
  9. Murphy MJ, Sheng X, MacDonald TM, Wei L. Hypertriglyceridemia and acute pancreatitis. JAMA Intern Med 2013;173(2):162-4. https://doi.org/10.1001/2013.jamainternmed.477
  10. Jeong JS, Kwon HS. Prevalence and Clinical Characteristics of Dyslipidemia in Koreans. Endocrinol Metab 2017;32(1):30-5. https://doi.org/10.3803/EnM.2017.32.1.30
  11. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A New Definition for Metabolic Associated Fatty Liver Disease: An International Expert Consensus Statement. J Hepatol 2020;73(1):202-9. https://doi.org/10.1016/j.jhep.2020.03.039
  12. Stone NJ, Robinson J, Lichtenstein AH, Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Circulation 2014;129(2):1-45. https://doi.org/10.1161/01.cir.0000442729.75315.83
  13. Zeng J, Yang RX, Sun C, Pan Q, Zhang RN, Chen GY, et al. Prevalence, clinical characteristics, risk factors, and indicators for lean Chinese adults with nonalcoholic fatty liver disease. World J Gastroenterol 2020;26(15):1792-804. https://doi.org/10.3748/wjg.v26.i15.1792
  14. Struben VM, Hespenheide EE, Caldwell SH. Nonalcoholic steatohepatitis and cryptogenic cirrhosis within kindreds. Am J Med 2000;108(1):9-13. https://doi.org/10.1016/s0002-9343(99)00315-0
  15. Salazar MR, Carbajal HA, Espeche WG, Leiva Sisnieguez CE, Balbin E, Dulbecco CA, et al. Relation among the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio, insulin resistance, and associated cardio-metabolic risk factors in men and women. Am J Cardiol 2012;109(12):1749-53. https://doi.org/10.1016/j.amjcard.2012.02.016
  16. Cone CJ, Bachyrycz AM, Murata GH. Hepatotoxicity associated with metformin therapy in treatment of type 2 diabetes mellitus with nonalcoholic fatty liver disease. Ann Pharmacother 2010;44(10):1655-9. https://doi.org/10.1345/aph.1P099
  17. Lee BW. Management of patients with nonalcoholic fatty liver disease with lifestyle modification. Korean Diabetes 2018;19(2):82-7. https://doi.org/10.4093/jkd.2018.19.2.82
  18. Woo HJ, Lee JH, Kim YC, Kim GS, Son CK, Jo JH, et al. Oriental Internal Medicine on Hepatobiliary System, Hematology and Toxicology 6th. Seoul: Nado; 2016, p. 321-8.
  19. Choi ES, Kim HY, Cho YH, Jang EG, Woo HJ, Kim YC, et al. A Case Report of Adolescent Nonalcoholic Fatty Liver Disease (NAFLD) with Severe Obesity. J Int Korean Med 2015;spr:89-95.
  20. Kang KR, Baek SH, Lee MS, Jung YJ, Choi AR, Shin JS. A Male Nonalcoholic Steatohepatitis (NASH) Patient Diagnosed with Moderate Fibrosis using Fibroscan-a Case Report. J Int Korean Med 2015;spr:120-6.
  21. Kim HY, Joo SH, Bae JH, Jang EG, Kim YC, Lee JH. A Case Report of Nonalcoholic Steatohepatitis with Metabolic Syndrome. J Int Korean Med 2017;38(2):125-30. https://doi.org/10.22246/jikm.2017.38.2.125
  22. Sin SM, Cha JH, Lim GT, Byun SH, Ko H. Saenggangeonbi-tang's effects on metabolic syndrome. J Int Korean Med 2008;fal:65-70.
  23. Lee SN, Kim SJ, Lee JS, Kim EG, Jang SG. Effect of Ganjeonggyeok Acupuncture and Saengkankunbi-tang Treatment in the Changes of LFT and Lipid-obesity Index Values. Journal of Acupuncture Research 2008;25(6):47-54.
  24. Whitfield JB. Gamma glutamyl transferase. Crit Rev Clin Lab Sci 2001;38(4):263-355. https://doi.org/10.1080/20014091084227
  25. Hsueh WA, Quinones MJ. Role of endothelial dysfunction in insulin resistance. Am J Cardiol 2003;92(4):10-7. https://doi.org/10.1016/S0002-9149(03)00611-8
  26. Fujii H, Doi H, Ko T, Fukuma T, Kadono T, Asaeda, K, et al. Frequently abnormal serum gamma-glutamyl transferase activity is associated with future development of fatty liver: a retrospective cohort study. BMC gastroenterology 2020;20(1):1-9. https://doi.org/10.1186/s12876-019-1136-4
  27. Tahan V, Canbakan B, Balci H, Dane F, Akin H, Can G, et al. Serum gamma-glutamyltranspeptidase distinguishes non-alcoholic fatty liver disease at high risk. Hepatogastroenterol 2008;55(85):1433-8.
  28. Mofrad P, Contos MJ, Haque M, Sargeant C, Fisher RA, Luketic VA, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatol 2003;37(6):1286-92. https://doi.org/10.1053/jhep.2003.50229
  29. Noureddin M, Loomba R. Nonalcoholic fatty liver disease: Indications for liver biopsy and noninvasive biomarkers. Clin Liver Dis 2012;1(4):104-7. https://doi.org/10.1002/cld.65
  30. Marotta T, Russo BF, Ferrara LA. Triglyceride-to-HDL-cholesterol ratio and metabolic syndrome as contributors to cardiovascular risk in overweight patients. Obesity 2010;18(8):1608-13. https://doi.org/10.1038/oby.2009.446