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替比夫定为口服核苷类似物,具有特异抗乙型肝炎病毒活性,是一种治疗慢性乙型肝炎有效方便的的药物。然而,近年时有替比夫定相关肌酸激酶(CK)升高和肌病的报道。为此,作者回顾有关医学文献,为临床安全应用该药提供依据。在GLOBE研究中,替比夫定相关CK升高为常见不良反应;CK3～4级升高的患者为7.5%～12.9%,但大多为一过性、可逆性或无症状,可自行恢复,罕见导致停药。替比夫定相关的肌病为少见不良反应。其发生率低于齐多夫定。但替比夫定上市后已有横纹肌溶解的个案报道。替比夫定的临床特点与他汀类药物不同,与齐多夫定相似。替比夫定相关的CK升高和肌病的确实机制不明。替比夫定治疗期间应加强CK的监测。一旦确定肌病和替比夫定有关应立即停药,必要时可用辅酶Q10治疗。
Telbivudine, an oral nucleoside analog, has specific anti-HBV activity and is an effective and convenient drug for the treatment of chronic hepatitis B. However, in recent years, telbivudine-related elevation of creatine kinase (CK) and myopathy have been reported. To this end, the author reviewed the medical literature, to provide the basis for the clinical safety of the drug. In the GLOBE study, telbivudine-related CK increased as a common adverse reaction; CK3 ~ 4 elevated in 7.5% to 12.9% of patients, but mostly transient, reversible or asymptomatic, self-recovery, Rare result in withdrawal. Telbivudine-related myopathy is a rare adverse reaction. Its incidence is lower than zidovudine. But telbivudine has been reported after the rhabdomyolysis case. Telbivudine has different clinical characteristics from statins and is similar to zidovudine. The exact mechanism of telbivudine-related CK elevation and myopathy is unknown. The telbivudine treatment should be strengthened during the monitoring of CK. Once identified myopathy and telbivudine should be immediately discontinued, if necessary, coenzyme Q10 treatment.