Infectious Diseases Section, 91599Nanjing Jiangbei Hospital, Nanjing, China.
Infectious Diseases Section, 12461Nanjing Pukou Central Hospital, Jiangsu Provincial People's Hospital Pukou Branch, Nanjing, China.
Int J Immunopathol Pharmacol. 2021 Jan-Dec;35:20587384211059676. doi: 10.1177/20587384211059676.
Entecavir (ETV) is widely used in the treatment of hepatitis B, but there are only a few reports about entecavir-associated thrombocytopenia, and it is considered as an immediate response and inappropriate to continue the treatment with other nucleoside analogues. Now, we report the third case, and this case was delayed response and we switched to treatment with tenofovir (TDF). There was a 66-year-old female who was infected with hepatitis B virus (HBV). Her platelet count decreased from 11110/L to 310/L and was prone to gum bleeding and skin ecchymosis after she received ETV treatment for 88 days. As a treatment option, ETV was replaced by TDF immediately, frequent platelets transfusions and thrombopoietin were applied for several days, daily prednisone of 50 mg was concomitantly taken, and then platelet count improved after 10 days. She was diagnosed with entecavir-associated thrombocytopenia after analysis of the temporal relationship and exclusion of other causes of thrombocytopenia by blood and bone marrow examinations. Our case suggested that the platelet count should be monitored regularly in patients during ETV treatment, and it may be a feasible option to choose TDF to maintain antiviral treatment when entecavir-associated thrombocytopenia occurs.
恩替卡韦（ETV）广泛用于乙型肝炎的治疗，但仅有少数关于恩替卡韦相关血小板减少症的报道，且其被认为是即刻反应，不宜继续使用其他核苷类似物进行治疗。现在，我们报告第三例病例，该病例为迟发性反应，我们将其转换为使用替诺福韦（TDF）进行治疗。这是一位 66 岁女性，感染乙型肝炎病毒（HBV）。她在接受 ETV 治疗 88 天后，血小板计数从 111×10/L 降至 3×10/L，且容易出现牙龈出血和皮肤瘀斑。作为一种治疗选择，我们立即将 ETV 替换为 TDF，并连续数日频繁输注血小板和应用促血小板生成素，同时每日服用 50mg 泼尼松，10 天后血小板计数开始改善。通过对血液和骨髓检查进行时间关系分析和排除其他血小板减少症病因后，诊断为恩替卡韦相关血小板减少症。我们的病例提示，在 ETV 治疗期间，患者应定期监测血小板计数，当发生恩替卡韦相关血小板减少症时，选择 TDF 维持抗病毒治疗可能是一种可行的选择。
