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1例42岁男性慢性乙型肝炎患者口服拉米夫定(100 mg,1次/d)和阿德福韦酯(10 mg,1次/d)治疗,约1个月后出现四肢肌肉酸痛、乏力,双下肢水肿。实验室检查:肌酸激酶9368 U/L,肌红蛋白>4317μg/L。肌电图示右侧三角肌肌源性损害。疑为横纹肌溶解症。停用拉米夫定及阿德福韦酯,肌酸激酶下降,肌无力症状好转。1年后,患者再次出现双下肢水肿并腹胀伴间断发热。肌酸激酶5546 U/L,肌红蛋白>1200μg/L,抗Jo-1抗体阳性。诊断:多发性肌炎,抗合成酶综合征。给予保肝、利尿、营养神经等治疗。2周后,加用恩替卡韦0.5 mg、1次/d抗病毒治疗。2个月后,给予糖皮质激素治疗。1个月后,患者四肢肌肉酸痛、无力症状基本缓解,复查肌酸激酶正常。
A 42-year-old man with chronic hepatitis B was treated with oral lamivudine (100 mg once daily) and adefovir dipivoxil (10 mg once daily), and muscle pain of the limbs occurred about 1 month later , Weakness, lower extremity edema. Laboratory tests: creatine kinase 9368 U / L, myoglobin> 4317μg / L. EMG right denervation muscle damage. Suspected rhabdomyolysis. Disable lamivudine and adefovir dipivoxil, creatine kinase decreased, muscle weakness symptoms improved. One year later, the patient developed secondary lower extremity edema and bloating with intermittent fever. Creatine kinase 5546 U / L, myoglobin> 1200μg / L, anti-Jo-1 antibody positive. Diagnosis: polymyositis, anti-synthetase syndrome. Give liver protection, diuretic, nutritional nerves and other treatment. After 2 weeks, plus entecavir 0.5 mg, 1 / d antiviral therapy. Two months later, glucocorticoid therapy was given. One month later, his limbs and muscles were sore and weakness was basically relieved. Creatine kinase was reexamined.