HBeAg阳性慢性乙型肝炎患者使用替比夫定治疗1年的血肌酸激酶水平变化及处理

Changes and management of blood creatine kinase in patients suffering from HBeAg-positive chronic hepatitis B treated with telbivudine for one year

目的:回顾性调查替比夫定治疗乙型肝炎病毒e抗原(hepatitis B eantigen,HBeAg)阳性慢性乙型肝炎过程中患者的血肌酸激酶(creatine kinase,CK)水平变化及处理,以期为临床安全用药提供参考。方法:回顾性地分析了24例使用替比夫定600mg/d治疗的HBeAg阳性慢性乙型肝炎患者的CK、乙型肝炎病毒(hepatitis B virus,HBV)DNA及其标记物等指标的检验结果。结果:患者治疗前及治疗3、6、9和12个月后的CK水平异常率分别为8.33%、12.50%、16.67%、45.83%和79.17%。CK水平最高值为2007U/L。有2例患者的CK水平在治疗9个月后达到最高,但在治疗12个月后较前有所下降;有17例患者的CK水平最高值出现在治疗12个月后,占70.83%。CK水平升高达到3～4级的有2例,其中治疗9和12个月后各有1例,均占4.17%。替比夫定治疗1年的谷丙转氨酶复常率为91.67%、乙型肝炎病毒表面抗原转阴率为4.17%、HBeAg转阴率为16.67%、HBVDNA转阴率为66.67%,有12.5%的患者出现病毒学突破。结论:替比夫定治疗引起CK水平升高较常见、但安全性尚好,需密切随访及监测患者的临床症状、CK水平、肾功能和肌红蛋白水平等。

Objective： To provide the basis for the safe use of telbivudine in clinical practice, the changes and management of blood creatine kinase （CK） in patients suffering from hepatitis B e antigen （HBeAg）-positive chronic hepatitis B treated with telbivudine were investigated retrospectively. Methods： The index results of CK, hepatitis B virus （HBV） DNA, and HBV marker and others of 24 patients suffering from HBeAg-positive chronic hepatitis B treated with telbivudine of 600 mg daily were analyzed retrospectively. Results： Abnormal rates of CK level were 8.33%, 12.50%, 16.67%, 45.83% and 79.17% before and after 3, 6, 9 and 12 months treatment respectively. The maximum value of CK level was 2 007 U/L. Maximum value of CK of two patients reached in 9 months of treatment and declined in 12 months. The maximum value of CK of 17 patients reached in 12 months, accounting for 70.83%. The level of CK of two patients reached levels of 3-4, one of whom （4.17%） was observed in 9 months and the other （4.17%） in 12 months. After 12 months of treatment with telbivudine, the normalization rate of alanine aminotransferase was 91.67%, clearance rate of hepatitis B virus surface antigen 4.17%, clearance rate of HBeAg 16.67%, HBV DNA negative conversion rate 66.67%, and 12.5% of patients ultimately developed virological breakthrough. Conclusion： Treatment of telbivudine causing elevation of serum CK is very common, but its safety is well, which needs close follow-up and monitors clinical symptoms, CK level, renal fimction, myoglobin, and so on.