Journal of Physiology & Pathology in Korean Medicine (동의생리병리학회지)

The Physiological Society of Korean Medicine and The Society of Pathology in Korean Medicine (대한동의생리학회·한의병리학회)
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Case Report of Liver Cirrhosis with Diabetes Mellitus and Hepatic Encephalopathy

당뇨병과 간성뇌증이 동반된 간경변증 1례

  • Na, Ran-Hee (Department of Internal Medicine, College of Oriental Medicine, Wonkwang University) ;
  • Lee, Jung-Wook (Department of Internal Medicine, College of Oriental Medicine, Wonkwang University) ;
  • Han, Deok-Jin (Department of Internal Medicine, College of Oriental Medicine, Wonkwang University) ;
  • Bang, Chang-Ho (Department of Internal Medicine, College of Oriental Medicine, Wonkwang University) ;
  • Jang, Seok-Oh (Department of Internal Medicine, College of Oriental Medicine, Wonkwang University) ;
  • Choi, Ji-Hye (Department of Internal Medicine, College of Oriental Medicine, Wonkwang University) ;
  • Kim, Kang-San (Department of Internal Medicine, College of Oriental Medicine, Wonkwang University)
  • 나란희 (원광대학교 한의과대학 한방내과학교실) ;
  • 이정욱 (원광대학교 한의과대학 한방내과학교실) ;
  • 한덕진 (원광대학교 한의과대학 한방내과학교실) ;
  • 방창호 (원광대학교 한의과대학 한방내과학교실) ;
  • 장석오 (원광대학교 한의과대학 한방내과학교실) ;
  • 최지혜 (원광대학교 한의과대학 한방내과학교실) ;
  • 김강산 (원광대학교 한의과대학 한방내과학교실)
  • Published : 2009.08.25
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Abstract

The liver is one of the principal organs involved in glucose metabolism. Diabetes mellitus(DM) commonly develops in patients with liver cirrhosis as a result of hepatocyte dysfunction. Hepatic encephalopathy(HE) is a major neuropsychiatric complication of liver cirrhosis. HE develops frequently in advanced stage of liver cirrhosis due to portal hypertension. We experienced a case of liver cirrhosis with DM and HE in 67 years old male patient. The patient's symptoms were lethargy, general malaise, asterixis, dizziness, and heavy headedness. Hwangryunjihwang-tang, Saengkankunbi-tang, Injinchija-tang and Injinho-tang were prescribed to the patient. Finally, the symptoms had been improved, however significant change was not observed from serum ammonia, fasting blood sugar and postparandial blood sugar. So we hope that this case report will be helpful in treating patient of liver cirrhosis.

Keywords

References

  1. 전국한의과대학 간계내과학교수. 간계내과학. 제4판. 서울, 동양의학연구원, pp 48, 323-350, 2001
  2. Harrison, S.A. Liver disease in patient with diabetes mellitus. J Clin Gastroenterol. 40: 68-76, 2006 https://doi.org/10.1097/01.mcg.0000190774.91875.d2
  3. Holstein, A., Hinze, S., Thiessen, E., Plaschke, A., Egberts, E.H. Clinical implications of hepatogenous diabetes in liver disease. J Gastroenterol Hepatol. 17: 677-681, 2002 https://doi.org/10.1046/j.1440-1746.2002.02755.x
  4. Riordan, S.M., Williams, R. Treatment of hepaticencephalopathy. N Eng J Med. 337: 473-479, 1997 https://doi.org/10.1056/NEJM199708143370707
  5. Merli, M., Riggio, O. Dietary and nutritional indications in hepatic encephalopathy. Metab Brain Dis. 24(1):211-221, 2009 https://doi.org/10.1007/s11011-008-9127-0
  6. 김정룡. 소화기계 질환 제2판. 서울, 일조각, pp 662-671, 708-718, 2005
  7. Naunyn, B. Der diabetes mellitus. Holder W, editor. pp 6-7, 1898
  8. Megyesi, C., Samols, E., Marks, V. Glucose tolerance and diabetes in chronic liver disease. Lancet. 2: 1051-1055, 1967
  9. Shmueli, E., Record, C.O., Alberti, K.G.M.M. Liver disease, carbohydrate metabolism and diabetes. In: Burger, H.G., ed. Bailliere's Clinical Endocrinology and Metabolism. 6th ed. London:WB Saunders. pp 719-743, 1992
  10. Creutzefeld, W., Frerichs, H., Sicklinger, K. Liver diseases and diabetes mellitus. In: Poppper, H., Schaffner, F., eds. Progress in Liver Diseases, 3rd ed. New York, Grune & Stratton Publishers. pp 371-407, 1970
  11. Petrides, A.S., Vogt, C., Schulze-Berge, D., Matthews, D., Strohmeyer, G. Pathogenesis of glucose intolerance and diabetes mellitus in cirrhosis. Hepatology. 19: 616-627, 1994 https://doi.org/10.1002/hep.1840190312
  12. Selberg, O., Burchert, W., vd Hoff, J., Meyer, G.J., Hundeshagen, H., Radoch, E., Balks, H.J., Müller, M.J. Insulin resistance in liver cirrhosis. Positron-emission tomography scan analysis of skeletal muscle glucose metabolism. J Clin Invest. 91(5):1897-1902, 1993 https://doi.org/10.1172/JCI116407
  13. Nolte, W., Hartmann, H., Ramadori, G. Glucose metabolism and liver cirrhosis. Exp Clin Endocrinol Diabetes. 103(2):63-74, 1995 https://doi.org/10.1055/s-0029-1211331
  14. 김민근, 최원충. 간경변증 환자에서 유발된 당뇨병과 다른 제2형 당뇨병 환자의 감별진단. 대한간학회지 12(4):524-529, 2006
  15. 손호영. 간경변증의 당뇨조절. 대한간학회 추계학술대회 초록집, 4(3s):1-7, 1998
  16. Ferenci, P., Lockwood, A., Mullen, K., Tarter, R., Weissenborn, K., Blei, A.T. Hepatic encephalopathy- definition, nomenclature, diagnosis, and quantification, final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 35(3):716-721, 2002 https://doi.org/10.1053/jhep.2002.31250
  17. Atterbury, C.E., Maddrey, W.C., Conn, H.O. Neomycin- sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy. A controlled, double-blind clinical trial. Am J Dig Dis, 23: 398-406, 1978 https://doi.org/10.1007/BF01072921
  18. Abou-Assi, S., Vlahcevic, Z.R. Hepatic encephalopathy : metabolic consequence of cirrhosis often is reversible. Postgrad Med. 109: 52-70, 2001 https://doi.org/10.3810/pgm.2001.02.850
  19. McDermott, W.V.Jr., Adams, R.D. Episodic stupor associated with an Eck fistula in the human with particular reference to the metabolism of ammonia. J Clin Invest. 33(1):1-9, 1954 https://doi.org/10.1172/JCI102862
  20. Butterworth, R.F. Hepatic encephalopathy:disorder of multiple neurotransmitter systems. In:Curr Opin Neurol. 13(6):721-727, 2000 https://doi.org/10.1097/00019052-200012000-00018
  21. Lockwood, A.H., Yap, E.W., Wong, W.H. Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. J Cereb Blood Flow Metab. 11(2):337-341, 1991 https://doi.org/10.1038/jcbfm.1991.67
  22. Cordoba, J., Lopez-Hellin, J., Planas, M., et al. Normal protein diet for episodic hepatic encephalopathy:results of a randomized study. J Hepatol. 41: 38-43, 2004 https://doi.org/10.1016/j.jhep.2004.03.023
  23. Shawcross, D., Jalan, R. Dispelling myths in the treatment of hepatic encephalopathy. Lancet. 365: 431-433, 2005 https://doi.org/10.1016/S0140-6736(05)70239-7
  24. Plauth, M., Merli, M., Kondrup, J., Weimann, A., Ferenci, P., Müller, M.J. ESPEN guidelines for nutrition in liver disease and transplantation. Clin Nutr. 16: 43-55, 1997
  25. Conn, H.O., Leevy, C.M., Vlahcevic, Z.R., et al. Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A Double blind controlled trial. Gastroenterology. 72: 573-583, 1997
  26. Clausen, M.R., Mortensen, P.B. Lactulose, disaccharides and colonic flora. Clinical consequences. Drugs. 53: 930-942, 1997 https://doi.org/10.2165/00003495-199753060-00003
  27. Hawkins, R.A., Jessy, J., Mans, A.M., Chedid, A., DeJoseph, M.R. Neomycin reduces the intestinal production of ammonia from glutamine. Adv Exp Med Biol. 368: 125-134, 1994
  28. 허준. 동의보감. 서울, 법인문화사, 2007
  29. 강신익, 박민호, 안세영, 두호경. 동의보감 소갈문에 수록된 처방들의 혈당강하효과에 대한 초보적 검색. 대한한의학회지 19(1):27-37, 1998
  30. 김병운. 만성간염 3,136예에 대한 임상분석과 생간건비탕의 치료효과. 대한한의학회지 14(1):216-223, 1997
  31. 김재용, 김영철, 이장훈, 우홍정. 생간건비탕이 HepG2 cell의 증식, 세포사멸 및 활성조절 신호전달계에 미치는 영향. 대한한방내과학회지 27(1):149-165, 2006
  32. 윤현정, 김병완, 이창현, 정재하, 허숙경, 박원환, 박선동. 사람 간암 세포주인 HepG2에 대한 인진호탕의 항암 효과. 대한본초학회지 22(3):27-37, 2007
  33. 김유창, 김승모, 박지하, 서부일, 최홍식. 인진호탕과 한인진호탕이 알코올 투여로 유발된 흰쥐의 고지혈증과 간 손상의 예방에 미치는 영향. 대한본초학회지 21(3):47-54, 2006
  34. 정승식, 최승훈, 안규석. 인진호탕 및 인진호탕가미방이 생쥐의 담석증모형에 미치는 영향. 대한동의생리학회지 6(1):159- 170, 1991
  35. 차종태. 치자대황탕과 인진치자탕 extract가 백서의 간손상에 미치는 영향. 대한한의학방제학회지 1(1):126-138, 1990