METHODS: The patient is a 51-year-old man who was hospitalized in November 2015. He had taken telbivudine regularly because of CHB. Later, tenofovir was added to antiviral treatment because of HBV resistance. Then he had myalgia, chest tightness and anorexia. The blood lactate was 12.7 mmol/L. The arterial blood gas analysis showed pH 7.25, base excess 21.1 mmol/L. CPK was 991 U/L, myoglobin was 1745 ng/ml and creatine was 83 μmol/L. Abdomen magnetic resonance revealed cirrhosis. Muscle biopsy revealed myogenic lesion with abnormality of mitochondria and fat metabolism. The patient was diagnosed with Hepatitis B envelope Antigen positive CHB, cirrhosis, LA and RM characterized by myalgia and elevated myoglobin. He was given tenofovir alone as antiviral treatment instead. After hemodialysis and 4 weeks` treatment of corticosteroids, his symptoms recovered, and blood lactate gradually returned to a normal range.
CONCLUSIONS: This case shows that tenofovir may trigger muscle damage and fatal RM in combination with telbivudine treatment in CHB patients. Thus, patients receiving tenofovir and telbivudine should be closely monitored for muscular abnormalities, blood lactate level and other mitochondrial toxicity associated side effects.
方法:患者为一名51岁男性,于2015年11月住院。由于CHB,他定期服用替比夫定。稍后,替诺福韦被添加到抗病毒治疗,因为HBV耐药。然后他有肌痛,胸闷和厌食症。血乳酸为12.7mmol/L动脉血气分析显示pH7.25,碱过量21.1mmol/L。CPK为991U/L,肌红蛋白为1745ng/ml,肌酸为83μmol/L。腹部磁共振显示肝硬化。肌肉活检显示肌源性病变伴线粒体和脂肪代谢异常。患者被诊断为乙型肝炎包膜抗原阳性CHB,肝硬化,以肌痛和肌红蛋白升高为特征的LA和RM。他单独给予替诺福韦作为抗病毒治疗。血液透析和糖皮质激素治疗4周后,他的症状恢复了,血乳酸逐渐恢复正常。
结论:该病例表明替诺福韦与替比夫定联合治疗CHB患者可能引发肌肉损伤和致命的RM。因此,接受替诺福韦和替比夫定的患者应密切监测肌肉异常,血乳酸水平和其他线粒体毒性相关的副作用。