替比夫定和拉米夫定治疗慢性乙型肝炎对肌酸激酶的影响

The study of the change in creatine kinase in patients with chronic hepatitis B during the antiviral treatment with Telbivudine and Lamivudine

目的分析替比夫定与拉米夫定在慢性乙型肝炎(CHB)抗病毒治疗中对肌酸激酶(CK)的影响。方法将参加007及015研究的52例患者随机分为替比夫定治疗组和拉米夫定治疗组,分别给予替比夫定600 mg/d和拉米夫定100 mg/d治疗104周。观察2组患者在不同时期CK的变化,并观察临床症状。结果在替比夫定组和拉米夫定组均观察到CK升高的现象,替比夫定组CK升高频率高于拉米夫定组(76%vs 44.4%),两组患者CK升高均没有出现症状。结论在应用核苷类似物抗病毒治疗过程中有可能出现CK升高。应用替比夫定治疗对CK影响大于拉米夫组,但多为1～2级(1～7×ULN)CK升高,且CK升高不是由于损伤心肌所致,常不伴随临床症状,不需要特殊干预,可以自行恢复正常。

Objective To compare the impact of creatine kinase（CK） on telbivudine and lamivudine in antiviral treatment.Methods 52 patients participated in 015 study and 007 study were randomly divided into two treatment groups assigned with telbivudine 600 mg daily and lamivudine 100 mg daily for 104 weeks respectively.CK elevation and clinical symptoms were observed in the two treatment groups at different peroids.Results CK elevation was observed in the two treatment groups,and the frequency was higher in telbivudine than that in lamivudine（76% vs 44.4%）.There was no symptom observed in the patients with CK elevation.Conclusion CK elevation is common in nucleoside analogue antiviral therapy.CK elevation frequency in telbivudine treatment groups was higher.Majority achieved grade 1-2 CK level elevation（1-7×ULN）.The cause of CK elevation was not induced by myocardial injury.All the patients had no symptoms.CK elevation in patients was transient and resolved without treatment.