误诊为药源性肌病的抗合成酶综合征1例  

Antisynthetase syndrome suspected as drug-induced myopathy:a case report

作　　者：王雪梅[1] 赵红[1] 张俊霞[1] 杨亚君[1] 蔡凤霞[1] 谢雯[1] 蔡晧东[1] 

机构地区：[1]首都医科大学附属北京地坛医院肝病中心,100015

出　　处：《药物不良反应杂志》2013年第6期353-354,共2页Adverse Drug Reactions Journal

摘　　要：1例42岁男性慢性乙型肝炎患者口服拉米夫定(100 mg,1次/d)和阿德福韦酯(10 mg,1次/d)治疗,约1个月后出现四肢肌肉酸痛、乏力,双下肢水肿。实验室检查:肌酸激酶9368 U/L,肌红蛋白>4317μg/L。肌电图示右侧三角肌肌源性损害。疑为横纹肌溶解症。停用拉米夫定及阿德福韦酯,肌酸激酶下降,肌无力症状好转。1年后,患者再次出现双下肢水肿并腹胀伴间断发热。肌酸激酶5546 U/L,肌红蛋白>1200μg/L,抗Jo-1抗体阳性。诊断:多发性肌炎,抗合成酶综合征。给予保肝、利尿、营养神经等治疗。2周后,加用恩替卡韦0.5 mg、1次/d抗病毒治疗。2个月后,给予糖皮质激素治疗。1个月后,患者四肢肌肉酸痛、无力症状基本缓解,复查肌酸激酶正常。A 42-year-old man with chronic hepatitis B was treated with combined use of lamivudine 100 mg once daily and adefovir dipivoxil 10 mg once daily. After a month the patient developed muscle aches in his extremities, asthenia and edema in his lower extremities. Laboratory tests showed that creatine kinase and myoglobin were 9368 U/L and 〉 4317 ~g/L, respectively. Electromyography indicated a myogenic lesion of right deltoid muscle. Rhabdomyolysis was suspected. Lamivudine and adefovir dipivoxil were stopped. The creatine kinase levels decreased and symptoms of muscular weakness improved. One year later, the patient had recurred edema in his lower extremities, abdominal distension and intermittent fever. Creatine kinase and myoglobin were 5546 U/L and 〉 1200 I^g/L, anti-Jo-1 antibody was positive. The patient was diagnosed with polymyositis and antisynthetase syndrome. He was given treatment with liver- protective, diuretics and neurotrophic agents. Two weeks later, he was given entecavir 0.5 mg once daily. Two months later, he was given glucocorticoid treatment. One month later, the muscle aches and asthenia imnroved, and his creatine kinase levels droooed to normal.

关 键 词：核苷酸类 多发性肌炎 抗合成酶综合征 

分 类 号：R589[医药卫生—内分泌]