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目的总结乙型肝炎肝硬化患者服用恩替卡韦过程中出现周围神经病变的临床特征和处理经验。方法自2011年7月至2013年7月解放军第302医院收治3例服用恩替卡韦过程中出现周围神经病变的乙型肝炎肝硬化患者,对其周围神经病变的临床特征进行总结。采用荧光定量PCR法检测HBV DNA,采用化学发光法检测血清HBs Ag和HBe Ag、甲状腺功能、维生素B12、叶酸,采用间接免疫荧光法检测自身免疫抗体,采用ICPMASS质谱分析法检测铅、镉等重金属,使用GE公司E9型超声仪检测四肢血管,使用丹麦维迪公司Keypoint型电生理仪检测神经传导速度和肌电图。结果 3例患者均为中年男性,在服用恩替卡韦3天~52周出现周围神经病变,主要表现为四肢末端麻木、疼痛,神经传导速度减慢,肌电图检查均正常;3例患者均停用恩替卡韦,更换为阿德福韦酯抗病毒治疗,并给予B族维生素、复合辅酶、前列地尔、丹参等药物治疗和物理治疗,患者不适症状在1周~5周内恢复,神经传导速度在16~61周内恢复,随访期间未出现复发。结论恩替卡韦可以导致乙型肝炎肝硬化患者出现周围神经病变,临床表现各异。一旦发生,应做到及时停用可疑药物、个体化处理,预后较好。
Objective To summarize the clinical features and treatment experience of peripheral neuropathy in patients with hepatitis B cirrhosis taking entecavir. Methods From July 2011 to July 2013, the clinical features of peripheral neuropathy in 3 patients with peripheral neuropathies who underwent entecavir treatment at the 302nd Hospital of People’s Liberation Army of China were retrospectively analyzed. HBV DNA was detected by fluorescence quantitative PCR, serum HBsAg and HBe Ag, thyroid function, vitamin B12 and folic acid were detected by chemiluminescence method, and the autoimmune antibodies were detected by indirect immunofluorescence. ICPMASS was used to detect heavy metals such as lead and cadmium , Using the GE company E9-type ultrasound system for detection of extremity blood vessels, the use of Danish Weidi company Keypoint electrophysiological detection of nerve conduction velocity and electromyography. Results All the 3 patients were middle-aged men. Peripheral neuropathy occurred in 3 days to 52 weeks after taking entecavir. The main symptoms were numbness of the extremities, pain, slowing of nerve conduction velocity and EMG examination. All 3 patients stopped With entecavir, to replace the adefovir dipivoxil treatment, and given B vitamins, coenzyme, alprostadil, Salvia and other drug treatment and physical therapy, patients with symptoms recovered within 1 week ~ 5 weeks, nerve conduction velocity Recover in 16 ~ 61 weeks, no recurrence during follow-up. Conclusion Entecavir can cause peripheral neuropathy in patients with hepatitis B cirrhosis and have different clinical manifestations. Once occurred, should be promptly discontinued suspicious drugs, individualized treatment, the prognosis is good.