恩替卡韦治疗慢性乙型肝炎患者导致横纹肌溶解1例

One case of entecavir-induced rhabdomyolysis in a patient with chronic hepatitis B

1例60岁男性慢性乙型肝炎患者因不规律服用抗病毒药物导致病毒反弹、肝功能异常,于2016年7月7日再次加用恩替卡韦0.5mg抗病毒治疗。后监测肝功能无显著改善,总胆红素呈上升趋势,TBil峰值为207.2μmol/L,PTA最低为53%。7月20日将恩替卡韦调整为1.0 mg,每晚1次。8月4日出现肌无力、肌痛等不适,肌红蛋白>1200 ng/ml;肌酸激酶41940 U/L;AST 1171 U/L;尿常规:pH7.00,BLD 300 cell/μl,RBC 36.75 p/HPF;头颅CT检查排除脑血管疾病。考虑恩替卡韦导致横纹肌溶解;将恩替卡韦减量为0.5 mg,每晚1次,并予大量水化、碱化尿液等治疗。患者四肢肌力较前恢复,肌红蛋白、肌酸激酶基本恢复正常。

A case of 60-year-old male patient with chronic hepatitis B was admitted for hepatic dysfunction caused by irregular use of antiviral drugs. He began to restart the antiviral therapy regularly with ETV 0.5 mg QN from July 7, 2016.Since there was no improvement of liver function during the monitoring, the total bilirubin was rising; the maximum value was up to 207.2 μmol/L, and PTA was declining; the minimum value arrived at 53%. Therefore, the dose of ETV was changed to 1 mg QN from July 20. On August 4, the patient began to occur muscle weakness, muscle pain and other uncomfortable symptoms, and the laboratory test showed myoglobin〉 1200 ng/ml, the creatine kinase was 41940 U/L, the aspertate aminotransferase was 1171 U/L. Routine urine： pH = 7.00, BLD＋＋＋ 300 cell/ml, RBC 36.75 p/HPF, the head CT scan was normal. Entecavir induced rhabdomyolysis was considered. So the dose of entecavir was adjusted to 0.5 mg,and the patient was treated with high dose of hydration, and alkalize urine therapy was used as well. Then the patient＆#39;s muscle symptoms recovered, and the myoglobin, creatine kinase returned to normal.