替比夫定治疗时血肌酸激酶升高现象的分析和处理

Analyzing and handling the elevated serum creatine kinase in telbivudine therapy

目的探讨服用替比夫定(TBV)后血肌酸激酶(CK)升高的慢性乙型肝炎(CHB)患者的临床特征与处理效果。方法回顾性分析21例CHB患者TBV单药治疗后CK升高情况及不同处理后生化、病毒学指标变化。结果本组患者每日服用TBV 600 mg后平均(10.9±5.2)个月测得血CK升高,其中8例伴肌肉酸痛、全身乏力。不同程度CK升高者分别继用TBV或换用阿德福韦或恩替卡韦后,平均(3.9±3.1)个月CK降至正常水平,且一定时间内血乙型肝炎病毒(HBV)DNA、丙氨酸氨基转移酶(ALT)降至检测限以下,HBeAg转阴率达60%(9/15)。结论及时发现和妥善处理服用TBV后血CK升高现象可维持该药疗效与安全性。

Purpose To explore clinical features and handling results of patients of chronic hepatitis B（CHB） with increased plasma creatine kinase（CK） due to telbivudine（TBV） treatment.Methods Retrospective analysis was used and related biochemical and virological items were observed on 21 cases of CHB treated with TBV alone.Results The patients were found with elevated blood CK after taking 600 mg TBV daily for average（10.9±5.2） months.8 cases of them had muscle pain and malaise.CK decreased to normal level in average（3.9±3.1） months when TBV was continued to be used or replaced by adefovir or entecavir,according to the elevated degree of CK.Within a certain period the serum ALT,HBVDNA declined to below the detection limits and clearance rate of HBeAg was 60%（9/15）.Conclusion Finding on time and treating properly the serum CK elevation during telbivudine therapy are helpful to maintain the drug efficacy and safety.