替比夫定单用及与阿德福韦或干扰素联用出现肌病的初步观察

Preliminary observation on myopathy occurring with telbivudine alone and telbivudine plus adefovir or interferon

目的:观察替比夫定单用及与阿德福韦或干扰素联用出现的肌病并分析其相关因素。方法:对2007年1月至2008年1月我院用替比夫定单药治疗及与阿德福韦或干扰素联合治疗出现肌病的5例患者进行调查,并对药物的用法用量,肌病的临床表现以及实验室检测结果进行分析。结果:5例患者均为男性,年龄25～45岁。1例服用替比夫定600mg,1次/d,治疗1个月。1例服用替比夫定600mg,2次/d,治疗2个月,后改为600mg,1次/d,并加用阿德福韦10mg,1次/d,治疗5个月。3例分别服用替比夫定600mg,1次/d,隔日肌内注射干扰素300万U,治疗3～9个月。5例患者均出现肌肉酸痛,全身乏力,其中1例伴有心肌受累,3例有神经症状。5例中有4例CK水平升高(311～900U/L)。结论:替比夫定单用或与阿德福韦或干扰素联用可能引起肌病,肌病严重程度可能与替比夫定的剂量有一定关联。

Objective： To observe the myopathy following telbivudine alone and telbivudine plus adefovir or interferon administration and analyze its relative factors. Methods： Five patients with myopathy related to telbivudine alone and telbivudine plus adefovir or interferon in our hospital from January 2007 to January 2008 were investigated. The dosage and administration of the drugs, the clinical manifestation of myopathy, and the results of laboratory testing were analyzed. Results： The 5 patients were men aged 25 - 45 years. One patient received telbivudine 600 mg once daily for 1 month. One patient received telbivudine 600 mg twice daily for 2 months, and subsequent regimen was changed to telbivudine 600 mg once daily plus adefovir 10 mg once daily for 5 months. Three patients received telbivudine 600 mg once daily plus intramuscular injection of interferon 3× 10^6 U every other day for 3 ～9 months, respectively. All five patients developed myalgia and generalized hypodynamia, and cardiac muscle was involved in one patient, and three patients presented with neurological disorders. Of 5 patients, 4 patients CK levels were 311 -900 U/L. Conclusion： Telbivudine alone and telbivudine plus adefovir or interferon might induce myopathy. And the dosage of telbivudine might be associated with the severity of myopathy in certain degrees.