核苷类似物致慢性乙型肝炎患者肌酸激酶增高的机制的初步研究  

A preliminary study on the mechanism of nucleoside analogues induced creatine kinase increasement in chronic hepatitis B patients

作　　者：郑嵘炅[1] 张丽娟[1] 张跃新[1] ZHENG Rong -jiong ZHANG Li -juan ZHANG Yue - xin(Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical U-niversity, Urumqi Xinjiang 830054 , China)

机构地区：[1]新疆医科大学第一附属医院感染性疾病诊疗中心,新疆乌鲁木齐830054

出　　处：《临床和实验医学杂志》2017年第9期856-859,共4页Journal of Clinical and Experimental Medicine

基　　金：新疆医科大学第一附属医院院内自然科学基金青年项目(编号:2013ZRQN07)

摘　　要：目的分别观察使用不同核苷类似物治疗的慢性乙型肝炎患者发生肌酸激酶增高的比率,同时明确肌酸激酶增高与人DNA聚合酶γ(POLγ)、人ATP酶(ATPase)的相关性,以及与POLG基因CAG-三核苷酸基因多态性的关系。方法测定使用替比夫定及恩替卡韦的患者入组第3个月,6个月及治疗满1年的肝功能及肌酸激酶水平,同时定量测定治疗前及治疗1年后人DNA聚合酶γ(POLγ)和人ATP酶(ATPase)的水平,检测患者POLG基因CAG-三核苷酸基因多态性。结果 50例使用替比夫定抗病毒治疗的患者在1年的随访中,发生肌酸激酶增高的患者共9例,均为一过性增高,可自行恢复正常,50例使用恩替卡韦抗病毒治疗的患者未发生肌酸激酶增高,所有随访患者治疗1年后POLγ和ATPase的测定无显著增高,肌酸激酶增高的发生与患者POLG基因CAG-三核苷酸基因多态性无相关性。结论慢性乙型肝炎患者长期使用核苷类似物抗病毒治疗发生的肌酸激酶多数为一过性,并未观察到对线粒体相关蛋白有影响,肌酸激酶增高的发生与患者POLG基因CAG-三核苷酸基因多态性未观察到相关性。Objective To observe the rate of the occurrence of creatine kinase increased by different nucleoside analogues in chronic hepatitis B patients,illustrate the correlation between creatine phosphokinase and human DNA polymerase gamma（ POL gamma）,ATP enzyme（ ATPase） correlation,gene polymorphism of the POLG gene CAG trinucleotide. Methods Liver function and CK level in patients taking telbivudine and entecavirthird after treatment in 3 months,in 6 months and 1 year were determined. Human DNA polymerase gamma（ POL gamma） and ATP enzyme（ ATPase） levels before treatment and after 1 year were quantitatively determined. Gene polymorphism of the POLG gene CAG trinucleotide were detected. Results A total of 9 cases occured creatine phosphokinase in 50 patients with telbivudine treated during 1 years of follow-up.Which were transient increase,and could return to normal. None creatine phosphokinase happend in 50 patients with entecavir treated during 1years of follow-up. POL gamma and ATPase were not significant increased before treatment and after 1 year. No correlation between creatine ki-nase increased trinucleotide occurrence and gene polymorphism of the POLG gene CAG trinucleotide were noticed. Conclusion Occurrence of creatine phosphokinase increasement is just temporary in patients with chronic hepatitis B,which have no effect on mitochondria related protein,there is no correlation between creatine kinase increased trinucleotide occurrence and gene polymorphism of the POLG gene CAG trinucleotide.

关 键 词：慢性乙型肝炎 核苷类似物 肌酸激酶 

分 类 号：R512.62[医药卫生—内科学]