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Abstract: Non-alcoholic fatty liver disease, also known as non-alcoholic fatty liver, is mostly associated with insulin resistance, obesity, and metabolic syndrome. In this case, the patient was a 58-year-old female with recurrent liver function abnormalities for 5 years and was diagnosed with nonalcoholic fatty liver disease by liver puncture pathology. After diagnosis, the patient was treated with liver-protective and enzyme-lowering therapy and weight loss, and the patient’s body mass index gradually returned to normal levels, liver function continued to be normal, and the fatty liver disappeared on repeat ultrasound.
Basic information】Female, 58 years old
Disease Type】Non-alcoholic fatty liver disease
Hospital】Huangshi Traditional Chinese Medicine Hospital
Date of Consultation】May 2021
Treatment plan】Medication (magnesium isoglycyrrhizate, polyenylphosphatidylcholine, silymarin) + weight loss (diet control + aerobic exercise)
Treatment period】Inpatient treatment for 2 weeks, outpatient review once a month for 6 months
Treatment effect】Body mass index gradually returned to normal, liver function continued to be normal, and fatty liver disappeared
I. Initial consultation
The patient reported that he visited an outside hospital 5 years ago due to abnormal liver function. Liver function tests indicated liver function destruction; ultrasound indicated fatty liver; alanine aminotransferase and aspartate aminotransferase fluctuated between 2 and 3 times the normal value. The indicators improved after he was given liver protection and enzyme-lowering treatment, but rebounded within a month after stopping the medication, during which he was hospitalized several times and checked the full set of viral hepatitis, autoimmune liver disease, genetic metabolic liver disease related indicators, etc. The indicators were all normal, excluding drug and alcohol poisoning, and he was given intermittent liver protection and Chinese medicine treatment. The results of liver function tests showed that aspartate aminotransferase 51(U/L) ↑ and alanine aminotransferase 100(U/L) ↑; ultrasound indicated severe fatty liver and preliminary diagnosis of non-alcoholic fatty liver disease.
Before treatment
II. Treatment history
I explained to the patient that there are many causes that can cause abnormal liver function, including viral hepatitis, fatty liver, alcoholic liver disease, autoimmune and genetic metabolism, hyperthyroidism, etc., especially non-alcoholic fatty liver disease, which is a diagnosis of exclusion and needs to be combined with liver aspiration results to confirm the diagnosis. After informed consent, a liver puncture was completed suggesting hepatocellular steatosis G2S2, which is the steatohepatitis stage of non-alcoholic steatohepatopathy, and the patient was admitted to the hospital. The patient was given medication to protect the liver and lower enzymes, which included magnesium isoglycyrrhizate, polyenylphosphatidylcholine, and silymarin; liver function gradually recovered after about 2 weeks of liver-protective treatment, and it was recommended to continue taking oral diammonium glycyrrhizate enteric capsules with weight loss. Weight reduction mainly consists of diet + exercise. For diet, daily caloric intake is 30-35 kal/kg; for exercise, daily aerobic exercise is not less than 150 minutes.
III. Treatment effect
Before treatment, the patient’s aspartate aminotransferase level was 51(U/L) ↑ and alanine aminotransferase level was 100(U/L) ↑; ultrasound indicated severe fatty liver; after about 2 weeks of liver-protective and enzyme-lowering treatment, the patient’s liver function basically returned to normal, and he was discharged successfully. The patient continued to take diammonium glycyrrhizate enteric capsules orally while instructing the patient to start to adhere to a controlled diet, eating 2 bites of staple food less at each meal, gradually and gradually, maintaining a daily caloric intake of 30-35 kal/kg according to the patient belonging to light manual labor; active exercise of not less than 6000 steps and aerobic exercise of not less than 150 minutes per week. Adhering to the diet + exercise therapy, the weight loss was 4kg in about 1 month, and the liver function continued to be normal on recheck. After stopping all the drugs, he continued to adhere to the diet + exercise therapy for 1 month, and continued to lose 4kg in weight, with normal liver function and ultrasound indicating mild fatty liver. The patient’s body mass index returned to the normal level, liver function continued to be normal, and the fatty liver disappeared on ultrasound after 3 months of the original treatment.
After discontinuing the drug + 1 month of continuous weight loss
After maintaining the original regimen for 3 months of continuous treatment
IV. Notes
In this case, the patient was cooperative and gradually improved. I was pleased with the patient’s persistence and the good trend of recovery. After the patient was discharged from the hospital, I advised him that even though he was discharged, he should still take his medication regularly at home during the treatment period and avoid strenuous exercise to the extent that his fatigue could be relieved within 15 minutes. After the liver function is restored to normal, weight loss should be actively carried out. In terms of diet, it is necessary to pay attention to the daily intake, mainly light and nutritious, and avoid the intake of large amounts of greasy food; and advocate moderate aerobic exercise, such as swimming, fast walking, cycling and other forms of exercise, to maintain a weight loss of 2-4 kg per month is appropriate, too fast may increase the burden on the liver. In addition, patients should maintain a happy mood, avoid excessive anxiety, and review regularly.
V. Personal insight
In the treatment of nonalcoholic fatty liver disease, according to domestic and international guidelines, diet and exercise are the basis of all treatment. Only for nonalcoholic fatty liver disease with elevated transaminases, appropriate liver-protective and enzyme-lowering drug therapy is considered, but drug therapy cannot fundamentally solve the problem of fat accumulation in liver tissues. Therefore, only consistent weight loss can fundamentally solve the problem of fatty liver, and diet and exercise are the healthy and safe treatment methods that should be advocated compared to the commonly used diet pills in the market.