Jia-Lin Jin, Piao Hu, Xiao-Yun Huang, Xin-Hua Weng, Ji-Ming Zhang, Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
World J Gastroenterol. 2013 Sep 7;19(33):5575-80. doi: 10.3748/wjg.v19.i33.5575.
All oral nucleoside analogues against hepatitis B virus, with an exception of telbivudine, have been reported causing lactic acidosis (LA). Here we report the first case of chronic hepatitis B developing severe refractory LA during telbivudine monotherapy. A 36-year-old man of Chinese origin received telbivudine antiviral treatment for chronic hepatitis B. After 11 mo of therapy, he developed anorexia, nausea, and vomiting with mild muscle weakness. The patient was found with elevated serum creatine phosphokinase up to 3683 U/L (upper limit of normal 170 U/L) and marked LA. LA did not resolve immediately following discontinuation of telbivudine. His condition began to improve after hemodialysis treatment for 16 times and usage of glucocorticosteroid. The patient fully recovered after 16 wk of treatment. This is the first documented case with severe LA caused by telbivudine monotherapy. Besides serum creatine phosphokinase, blood lactate level should also be closely monitored in patients receiving telbivudine.
所有的口服核苷类似物抗乙型肝炎病毒药物（除替比夫定外）都有引发乳酸酸中毒（LA）的报告。本文报道了首例慢性乙型肝炎患者在替比夫定单药治疗期间发生严重难治性 LA 的病例。一名 36 岁的中国男性因慢性乙型肝炎接受替比夫定抗病毒治疗。治疗 11 个月后，他出现厌食、恶心和呕吐伴轻度肌无力。患者血清肌酸磷酸激酶升高至 3683 U/L（正常值上限 170 U/L），同时出现明显的 LA。停用替比夫定后，LA 并未立即缓解。经过 16 次血液透析治疗和糖皮质激素的使用后，患者的病情开始好转。经过 16 周的治疗，患者完全康复。这是首例由替比夫定单药治疗引起的严重 LA 的病例。除了血清肌酸磷酸激酶外，接受替比夫定治疗的患者还应密切监测血乳酸水平。
