【摘要】 1例老年慢性乙型病毒性肝炎肝硬化男性患者规律服用恩替卡韦（0.5 mg,qd）抗病毒治疗,用药32个月后出现明显肌力减退、活动耐量降低,伴双下肢凹陷性水肿,同时合并肺部感染及腹水。实验室检查示:天冬氨酸转氨酶403 U·L^-1,丙氨酸转氨酶87 U·L^-1,白蛋白27.0 g·L^-1,球蛋白26.4 g·L^-1,总胆红素40.27μmol·L^-1,尿素氮14.99 mmol·L^-1,磷酸肌酸激酶10 944 U·L^-1,肌红蛋白1 381.7μg·L^-1,乳酸脱氢酶447 U·L^-1,乳酸1.9 mmol·L^-1。考虑长期使用恩替卡韦相关的药物性肌病。经停用恩替卡韦及碱化尿液、利尿、护肝降酶、补充白蛋白、抗感染等对症治疗,实验室各项指标进行性下降并接近正常,症状逐步改善,住院16 d后出院。临床医生应关注恩替卡韦引起的药物性肌病。更多还原

【Abstract】 An old man with chronic hepatitis B cirrhosis received entecavir（0.5 mg,qd） regularly for anti-HBV treatment.After 32 months the patient developed myodynamia subsidence obviously,activity intolerance,accompanying both lower extremities pitting edema,pulmonary infection and ascites.Laboratory examination showed AST 403 U·L^-1,ALT 87 U·L^-1,ALB27.0 g·L^-1,GLB 26.4 g·L^-1,TBIL 40.27 μmol·L^-1, BUN 14.99 mmol·L^-1,CK 10 944 U·L^-1,MGB 1 381.7 μg·L^-1,LDH 447 U·L^-1,Lac 1.9 mmol·L^-1.Myopathy assoiated with long-term use of entecavir was suspected.After suspending entecavir and symptomatic treatment such as alkalinizing urine,diuresis,protecting liver and lowering enzyme,supplementing albumin and antiinfection,the results of laboratory examination dropped progressively and approached to normal,symptom improved gradually.The patient was discharged after 16 days’ hospitalization.Clinical physician should therefore pay close attention to drug-induced myopathy associated with entecavir.更多还原