替比夫定相关致命性乳酸酸中毒并多器官功能障碍综合征1例  

A case of telbivudine-related fatal lactic acidosis and multiple organ dysfunction syndrome

作　　者：佘长寿 邓跃林[1] SHE Changshou;DENG Yuelin(Department of Emergency, Xiangya Hospital, Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅医院急诊科

出　　处：《中南大学学报（医学版）》2019年第6期714-719,共6页Journal of Central South University ：Medical Science

摘　　要：替比夫定相关不良反应报道逐渐增多,较常见的有肌酶及乳酸水平升高。中南大学湘雅医院收治1例长期口服替比夫定的23岁男性患者,临床主要表现为进行性肌痛,逐渐进展至神志障碍,同时合并多器官功能障碍,其中乳酸水平明显升高,代谢性酸中毒极为严重,病情凶险,诊断为替比夫定所致罕见严重不良反应。给予血液净化、碳酸氢钠纠正酸中毒,头孢他啶抗感染,停用替比夫定,改用替诺福韦二吡呋酯并护肝等治疗,患者病情好转出院。此类患者早期极易误诊为神经肌肉系统疾病,延误治疗,导致病情恶化,临床医生需提高警惕,早期识别,避免误诊。The incidence of telbivudine-related adverse reactions has been gradually increased. Th e increased levels of muscle enzymes and blood lactate are common. In this case, a 23-year-old male patient with long-term oral telbivudine had a rare serious adverse reaction. Th e main clinical manifestations were progressive myalgia, gradually progressed to mental disorder, and together with multiple organ dysfunction, in which the level of blood lactate was increased signi fi cantly and metabolic acidosis was extremely severe. Blood puri fi cation and sodium bicarbonate were given to correct acidosis, while ceftazidime was used to prevent infection. Telbivudine was discontinued, and tenofovir disoproxil fumarate and liver protective drug were used. Th e patient was discharged with a be t ter health condition. Such patients are easily misdiagnosed as neuromuscular diseases in the early stage, which might delay the treatment and worsen medical conditions. Clinicians need to be cautious and obtain an early identi f ication to avoid misdiagnosis.

关 键 词：替比夫定 乳酸酸中毒 横纹肌溶解 多器官功能障碍综合征 持续血液净化 

分 类 号：R595.4[医药卫生—内科学]