恩替卡韦治疗慢性乙型肝炎患者导致横纹肌溶解1例.PDFVIP

《中国肝脏病杂志（电子版）》2017年第9卷第1期 ·病例报告· 91 恩替卡韦治疗慢性乙型肝炎患者 导致横纹肌溶解1例 刘玉凤, 熊号峰, 刘景院, 李传胜, 谭建波（首都医科大学附属北京地坛医院 重症医学科，北京 100015 ） 1 60 2016 摘要： 例 岁男性慢性乙型肝炎患者因不规律服用抗病毒药物导致病毒反弹、肝功能异常，于 7 7 0.5mg 年 月 日再次加用恩替卡韦 抗病毒治疗。后监测肝功能无显著改善，总胆红素呈上升趋势， TBil 207.2 μmol/L PTA 53% 7 20 1.0 mg 8 4 峰值为 ， 最低为 。 月 日将恩替卡韦调整为 ，每晚1次。 月 日出 现肌无力、肌痛等不适，肌红蛋白＞ 1200 ng/ml ；肌酸激酶41940 U/L ；AST 1171 U/L ；尿常规：pH 7.00 ，BLD 300 cell/μl ，RBC 36.75 p/HPF ；头颅CT检查排除脑血管疾病。考虑恩替卡韦导致横纹肌 溶解；将恩替卡韦减量为0.5 mg ，每晚1次，并予大量水化、碱化尿液等治疗。患者四肢肌力较前恢 复，肌红蛋白、肌酸激酶基本恢复正常。 关键词：恩替卡韦；不良反应；横纹肌溶解 One case of entecavir-induced rhabdomyolysis in a patient with chronic hepatitis B LIU Yu-feng, XIONG Hao-feng, LIU Jing-yuan, LI Chuan-sheng, TAN Jian-bo (Intensive Care Unit, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China) Abstract: A case of 60-year-old male patient with chronic hepatitis B was admitted for hepatic dysfunction caused by irregular use of antiviral drugs. He began to restart the antiviral therapy regularly with ETV 0.5 mg QN from July 7, 2016. Since there was no improvement of liver function during the monitoring, the total bilirubin was rising; the maximum value was up to 207.2 μmol/L, and PTA was declining; the minimum value arrived at 53%. Therefore, the dose of ETV was changed to 1 mg QN from July 20. On August 4, the patient began to occur muscle weakness, muscle pain and other uncomfortable symptoms, and the laboratory test showed myoglobin ＞ 1200 ng/ml, the creatine kinase was 41940 U/L, the aspertate aminotransferase was 1171 U/L. Routine urine: pH = 7.00, BLD+++ 300 cell/ml, RBC 36.75 p/HPF, the head CT scan was normal. Entecavir induced rhabdomyolysis was considered. So the dose of entecavir was adjusted to 0.5 mg, and the patient was