(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: A 45-year-old male patient with no long-term history of alcohol abuse, who was found to have elevated transaminases on physical examination for 2 years and was treated intermittently with mild to severe disease. 1 month ago, the liver function transaminases were again elevated on rechecking, the five hepatitis B tests showed positive surface antibodies, negative hepatitis C antibodies, abdominal ultrasound suggested fatty liver, and he came to the hospital with suspicion of other diseases, and was diagnosed with non-alcoholic steatohepatitis. After dietary management and medication, the disease was controlled.
Basic information】Male, 45 years old
Type of disease】Non-alcoholic steatohepatitis
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Date of consultation】September 2021
Treatment plan】Medication (magnesium isoglycyrrhizate injection + reduced glutathione tablets + silymarin capsules) + lifestyle modification
Treatment period】17 days of inpatient treatment, 2 months of outpatient follow-up
Treatment effect] The disease was controlled and the liver function was normalized in the review.
I. Initial consultation
A middle-aged male patient came to the outpatient clinic complaining of elevated transaminases for 2 years intermittently, normal hepatitis B and C in laboratory tests, normal blood lipids, no history of long-term alcohol consumption, ultrasound suggesting fatty liver, but liver function was not normal, so he came to the clinic because of suspicion of other diseases. After detailed medical history, we learned that although the patient had no history of hepatitis B and C and alcoholism, he had abnormal blood glucose, which often fluctuated around 8 mmol/L. In addition, the patient was sedentary in office for a long time and liked to eat high fructose, greasy food and drinks, which led to the increase of blood glucose. In contrast, diabetes mellitus and obesity are susceptibility factors for nonalcoholic steatohepatitis. Therefore, based on the medical history and laboratory tests provided by the patient, a preliminary diagnosis of nonalcoholic steatohepatitis was made.
II. Treatment history
The patient’s liver function was repeatedly abnormal, which seriously affected his normal work and life, and he was worried about the combination of other diseases, so he was recommended to be admitted to the hospital for a comprehensive examination. mmol/L, HDL 1.13 mmol/L. Liver puncture biopsy was considered non-alcoholic steatohepatitis, so he was given magnesium isoglycyrrhizate injection, reduced glutathione tablets, and silymarin capsules to control hepatocyte inflammation, antioxidant, and protect hepatocyte membranes, and to calm anxiety, and it was recommended to correct malpractice by strengthening exercise and healthy diet lifestyle.
III. Treatment effect
Through the patient’s treatment of changing the diet structure, strengthening exercise, and controlling hepatocyte inflammation and protecting hepatocyte membrane for 17 days, as well as excluding other metabolic diseases after performing liver puncture biopsy, the patient’s psychological stress was significantly reduced and his anxiety was relieved. The patient’s liver function returned to normal, with total bilirubin 13.2μmol/L, glutathione aminotransferase 26U/L, and glutathione aminotransferase 19U/L, while fasting blood sugar was controlled at 6.49μmol/L. The patient was instructed to review outpatient clinic in 2 months.
IV. Notes
We are glad that the patient was admitted to the hospital and the diagnosis was clear after liver preservation therapy and liver aspiration biopsy, and the patient recovered from the disease. It is recommended to continue liver-protective treatment after discharge, add glucose-lowering drugs if necessary, do not stop the drugs on your own, control your weight, but pay attention to the rapid weight loss that causes liver damage, change your lifestyle, and avoid using drugs that are damaging to the liver. It is recommended to review liver function, blood lipids, blood sugar and abdominal ultrasound every 2 months, and non-invasive diagnostic test for liver hardness for liver fibrosis if possible, in order to understand the changes of the disease and adjust the treatment plan in time.
V. Personal insight
Non-alcoholic steatohepatitis refers to the absence of a long-term history of heavy alcohol consumption and exclusion of other diseases causing hepatic steatosis. Common symptoms caused by abdominal obesity, diabetes, hyperlipidemia, metabolic disorders, a sedentary lifestyle, and a high-calorie dietary structure. The patient is a long-term sedentary office, preferring high fructose, greasy food and beverage intake, which leads to elevated blood sugar. However, this disease is a preventable and controllable disease, more than 60% of patients can be reversed by weight loss and changing the diet structure. If the effect of diet and weight control is not good in 3-6 months, liver-protective, glucose-lowering and lipid-lowering drugs can be added, and most of them can achieve good results.