替比夫定相关肌病和周围神经病(附5例报告及文献复习)

Telbivudine-associated Myopathy and Neuropathy(Reports of Five Cases and Literature Review)

目的探讨替比夫定相关肌病和周围神经病的临床表现、辅助检查结果、病理特点及可能的致病机制。方法回顾性分析5例替比夫定相关肌病和周围神经病患者的临床特点、辅助检查及肌肉病理特点,结合文献复习分析讨论。结果 5例患者中男4例、女1例;平均起病年龄(43.8±10.5)岁;平均用药至起病时间(9.2±4.4)个月。替比夫定用量均为600 mg,qd。主要临床症状为无力、恶心呕吐、肢体麻木,有2例患者伴有乳酸性酸中毒。实验室检查可见肌酸激酶和血乳酸明显升高。3例患者肌电图提示肌源性损害,2例患者提示肌源性伴周围神经损害,且以轴索损害为主。肌肉活检5例均见线粒体功能异常。停药及对症治疗后肌无力症状均有所恢复,麻木症状恢复欠佳。结论替比夫定相关肌病及周围神经病与线粒体功能障碍密切相关,周围神经损害以轴索为主,替比夫定相关肌病预后良好。

Aim To investigate the clinical characteristics, auxiliary examinations, pathological features and the possible mechanism of telbivudine-associated myopathy and neuropathy. Methods The medical history, auxiliary examinations, and pathological features on muscle biopsy of 5 cases were retrospectively analyzed. Related literature were reviewed. Results A total of 5 patients（4 males and 1 female） with an average age of（43.8±10.5） years at on set were included. The mean duration between telbivudine therapy（with a daily dosage of 600 mg） and manifestation was（9.2±4.4） months. Clinical symptoms included weakness, nausea, vomiting and numbness of limbs. Two patients suffered from lactic acidosis as well. CK levels and blood lactic acid were markedly elevated. Electromyography indicated myogenic damage in alland neurogenic damage in two of them. Muscle biopsy revealed mitochondrial dysfunction in all patients. Muscle weakness was partially recovered in 3~6 months after withdrawal of telbivudine, but numbness persisted. Conclusion Neuromuscular function should be carefully monitored in patients on telbivudine therapy. Mitochondrial dysfunction might mainly contribute to the pathogenesis of telbivudine-associated myopathy and neuropathy. The prognosis of telbivudine-associated myopathy is generally favorable.