Caroleo Benedetto, Galasso Olimpio, Staltari Orietta, Giofrè Chiara, De Sarro Giovambattista, Guadagnino Vincenzo, Gallelli Luca
Department of Health Science School of Medicine, University "Magna Graecia" of Catanzaro, Italy.
Muscles Ligaments Tendons J. 2011 Dec 29;1(2):57-60. Print 2011 Apr.
Muscle tissue damage might be related to metabolic and mechanical factors. Certain drugs have been associated with increased blood levels of creatin phospho kinase (CPK) and myoglobin that are biochemical markers of musculoskeletal damage. An increase of CPK plasma levels might suggest severe rhabdomyolysis with possible resulting renal failure. Telbivudine is an antiviral drug indicated for the treatment of chronic hepatitis B (CHB) in adult patients. An increase in CPK plasma levels has been recently described in some telbivudine-treated CHB patients without muscle-skeletal symptoms. In this paper we report a CHB patient that developed a severe increase of CPK plasma levels during telbivudine-treatment. Pharmacological evaluation, using the Naranjo probability scale, indicated a probable relationship between telbivudine and CPK increase, so telbivudine was discontinued and replaced with entecavir with a complete resolution of laboratory findings. In conclusion, telbivudine treatment can induce muscular damage in the absence of skeletal injury, therefore we suggest to closely monitor the muscular function of the patients treated with this drug in order to prevent possible major complications.
肌肉组织损伤可能与代谢和机械因素有关。某些药物与肌酸磷酸激酶（CPK）和肌红蛋白血液水平升高有关，这些是肌肉骨骼损伤的生化标志物。CPK血浆水平升高可能提示严重横纹肌溶解，并可能导致肾衰竭。替比夫定是一种抗病毒药物，用于治疗成年慢性乙型肝炎（CHB）患者。最近在一些接受替比夫定治疗的CHB患者中发现，其CPK血浆水平升高，但无肌肉骨骼症状。本文报告了1例CHB患者，在替比夫定治疗期间CPK血浆水平严重升高。使用Naranjo概率量表进行的药理学评估表明，替比夫定与CPK升高之间可能存在关联，因此停用替比夫定，改用恩替卡韦，实验室检查结果完全恢复正常。总之，替比夫定治疗可在无骨骼损伤的情况下引起肌肉损伤，因此我们建议密切监测使用该药物治疗患者的肌肉功能，以预防可能出现的严重并发症。
