替比夫定及干扰素相关肌炎及周围神经病

Myositis and peripheral neuropathy associated with telbivudine and interferon

1例31岁女性患者,因慢性乙型病毒性肝炎给予替比夫定600mg,1次/d。持续治疗10个月后加用干扰素300万U,隔日1次皮下注射。9个月后,停用干扰素,替比夫定继续使用。患者出现下肢麻木,进行性加重。随后出现明显肌痛,下肢无力,感觉异常。查体:四肢末梢型痛觉稍减退,双下肢腱反射减弱,下肢末端皮肤稍苍白,左足拇趾甲灰变。实验室检查:CK1694.3U/L。运动神经传导速度检查显示左腓总神经远端潜伏期延长,波幅减低;感觉神经传导速度检查显示左胫神经传导速度偏慢。停用替比夫定,改用拉米夫定,并给予维生素B1及辅酶Q10口服。2个月后症状好转。

A 31-year-old woman received telbivudine 600 mg once daily for chronic viral hepatitis B. After 10 months of therapy,SC interferon 3 million units every other day was added to her regimen. After 9 months of treatments,interferon was stopped and telbivudine was continued. The patient developed numbness in both lower limbs and her symptoms aggravated. Subsequently,she experienced obvious myalgia,weakness in lower extremities,and paresthesia. Physical examinations showed slight hypoalgesia in peripheral extremities,weak tendon reflex in both lower limbs,slightly pale skin in her distal lower extremities,and grey nail in left hallux. Laboratory test showed a CK level of 1 694.3 U/L. Motor nerve conduction velocity tests revealed increased latency and decreased amplitude in her distal left nerus peroneus communis; sensory nerve conduction velocity tests revealed slow velocity in her left tibial nerve. Telbivudine was withdrawn and switched to lamivudine. Meanwhile she was treated with vitamin B1 and coenzyme Q10. Two months later,her symptoms improved.