替比夫定治疗慢性乙型肝炎患者肌酸激酶增高现象分析  

Analysis of telbivudine treatment induced creatine kinase elevation in patients with chronic hepatitis B

作　　者：陈娟[1] 赵洪雯[2] 邓玲[1] 朱研[1] 张长江[1] 王小红[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所、感染病研究重庆市重点实验室,重庆400038 [2]第三军医大学西南医院肾科,重庆400038

出　　处：《肝脏》2016年第5期334-337,共4页Chinese Hepatology

摘　　要：目的研究替比夫定（LdT）治疗慢性乙型肝炎（CHB）患者的肌酸激酶（CK）增高情况、增高后的处理及危险因素，评估LdT使用的安全性。方法纳入LdT治疗CHB患者527例，其中联合阿德福韦酯（ADV）91例、LdT单独治疗436例。合并慢性肾脏病（CKD）19例，孕妇58例。观察CK动态变化，肌肉症状，基线及观察结束时病毒、免疫、生化学指标等。结果321例患者出现CK升高，1～2级增高281例，3-4级增高40例，发生肌炎14例。CK3～4级增高后换药与不换药组CK下降差异无统计学意义（P=0．16）。男性是CK增高的危险因素（P〈0．01），妊娠与CKD为保护因素（P〈O．01；P=0．003）。结论LdT抗病毒治疗过程中出现CK增高是普遍现象（孕妇及合并CKD患者除外），加强监测能提高LdT应用的安全性。Objective To investigate clinical features of tebivudine(LdT)induced creatine kinase(CK)elevation and its risk factors in chronic hepatitis B(CHB)patients,and to evaluate safety of LdT.Methods A total of 527 CHB patients were enrolled in this study,and their clinical data was retrospectively analyzed.Among these patients,91 received LdT plus adefovir dipivoxil(ADV)therapy and 436 received LdT monotherapy,including 19 with CHB concomitant chronic renal disease(CKD)and 58 pregnant women.The CK levels and muscle symptoms were dynamically observed,and virus,immune and biochemical markers both at baseline and the end of therapy were detected,respectively.Results Variable degrees of CK elevation occurred in 321 cases(60.91%),in which 281 cases(53.32%)were in grade 1-2 and 40 cases(7.59%)were in grade 3-4.Additionally,14 patients(2.65%)were diagnosed as myositis.In patients with CK elevation of grade 3-4,there was no significant difference between the 2 groups(P=0.16).Male was a risk factor for CK elevation with LdT treatment(P<0.001),while pregnance and CKD were protective factors(P<0.001;P=0.003).Conclusion It is quite common of CK elevation in CHB patients treated with LdT,which suggests that strengthening monitor of CK is indispensable for avoiding LdT-induced serious adverse effects.In regard to LdT-induced CK elevation,application of LdT in HBV-infected pregnant women and patients with CHB concomitant CKD might be safe.

关 键 词：慢性乙型肝炎 替比夫定 肌酸激酶 肌炎 

分 类 号：R512.62[医药卫生—内科学]