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大規模データベースを用いたNAFLD患者における薬剤処方状況と他臓器障害に関する解析

町田, 俊也 東北大学

2023.03.24

概要

緒論の通り,NAFLD に対する 2 型糖尿病,高血圧症,脂質異常症治療薬の効果が検
討され,肝機能検査値や肝組織像の改善効果が報告されている。これらのエビデンスに
基づき,NAFLD 診療ガイドラインでは,2 型糖尿病,高血圧症,脂質異常症が合併する
場合,特定の治療薬を使用すること,もしくは使用しないことが推奨・提案されている。
Table 1 に,NAFLD/NASH 診療ガイドライン 2020(改訂第 2 版)
(日本消化器病学会,
日本肝臓学会)9 の 2 型糖尿病,高血圧症,脂質異常症治療薬に関する記載を整理した。
2 型糖尿病治療薬のうち,チアゾリジン誘導体(ピアグリタゾン)は,脂肪沈着,風
船用変性,小葉の炎症などの肝組織像の改善に有益であることから,2014 年発行の診
療ガイドラインから 2 型糖尿病を合併する NASH 患者への投与が推奨されている。加
えて,2020 年発行の診療ガイドラインでは,
ナトリウム-グルコース共輸送体 2
(sodiumglucose cotransporter-2: SGLT2)阻害薬とグルカゴン様ペプチド-1(glucagon-like peptide1: GLP-1)受容体作動薬が,肝機能検査値と肝組織像の改善に有益であるとして投与の
提案が追加された。一方,ビグアナイド系薬(メトホルミン)は肝機能検査値および肝
組織像の改善の根拠に乏しいため,投与しないことが提案されている。
高血圧症治療薬のうち,アンジオテンシン II 受容体拮抗薬(angiotensin 2 receptor
blocker: ARB)が,肝機能検査値や肝細胞死および肝線維化等の肝組織像の改善に有益
であることが少数のエビデンスから示唆されており,高血圧症を合併した NAFLD に推
奨されている。加えて,2020 年発行の診療ガイドラインでは,アンジオテンシン変換酵
素(angiotensin-converting enzyme: ACE)阻害薬の使用も推奨されている。
脂質異常症治療の適応を有する治療薬では,ビタミン E(トコフェロール)が肝機能
検査値および肝組織像の改善効果に基づいて,NASH 患者への使用が推奨されている。 ...

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