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1例26岁男性患者,因双下肢肌痛、胸闷和心悸入院治疗。患者入院时尿少,呈酱油色,BP 80/50 mm Hg,HR 120次/min。实验室检查:CK906 U/L,CK-MB 100 U/L,ALT310 U/L,AST369 U/L;尿常规:WBC 1 493.2/μl,RBC 193.1/μl,管型65/μl,病理性管型(+),胆红素(++),潜血(++),蛋白(++),比重1.030;血气分析:pH值6.9,PO264 mm Hg。考虑为代谢性酸中毒,给予5%碳酸氢钠静脉滴注。追问病史,患者有慢性乙型肝炎史,并服用替比夫定600 mg,1次/d,共11个月余。查血肌红蛋白>500 ng/ml,诊断为替比夫定相关横纹肌溶解症。给予血液滤过,甲泼尼龙及其他对症治疗,并停用替比夫定,改为恩替卡韦。住院第2天,患者CK峰值为1300 U/L,CK-MB 61 U/L,ALT512 U/L,AST579 U/L。4 d后尿量恢复正常,肾功能逐渐恢复正常。住院第12天,患者双下肢肌痛明显好转,四肢肌力达Ⅳ级,CK 144 U/L,CK-MB 15.1 U/L,ALT57 U/L,AST34 U/L,电解质正常。
A 26-year-old male patient admitted to hospital for treatment of bilateral lower extremity myalgia, chest tightness and heart palpitations. Patients admitted to the hospital less urine, was soy sauce color, BP 80/50 mm Hg, HR 120 beats / min. Laboratory tests: CK906 U / L, CK-MB 100 U / L, ALT310 U / L, AST369 U / L; urine routine: WBC 1 493.2 / (+), Bilirubin (++), occult blood (++), protein (++), specific gravity 1.030; blood gas analysis: pH 6.9, PO264 mm Hg. Consider metabolic acidosis, given 5% sodium bicarbonate intravenously. Question history, patients with chronic hepatitis B history and taking telbivudine 600 mg, 1 / d, a total of more than 11 months. Check hemoglobin> 500 ng / ml, diagnosed as telbivudine-related rhabdomyolysis. Give hemofiltration, methylprednisolone and other symptomatic treatment, and discontinued telbivudine to entecavir. On the second day of hospitalization, patients had peak CK of 1300 U / L, CK-MB 61 U / L, ALT512 U / L, and AST579 U / L. Urine volume returned to normal after 4 days, and renal function gradually returned to normal. On the 12th day of hospitalization, the patients with bilateral lower extremity muscular pain improved significantly, and the muscle strength of the four limbs reached grade IV, CK144U / L, CK-MB15.1U / L, ALT57U / L, AST34U / L, electrolyte normal.