CAJ | 학술논문

1例42岁男性慢性乙型肝炎患者口服拉米夫定(100 mg,1次/d)和阿德福韦酯(10 mg,1次/d)治疗,约1个月后出现四肢肌肉酸痛、乏力,双下肢水肿.实验室检查:肌酸激酶9368 U/L,肌红蛋白＞4317 μg/L.肌电图示右侧三角肌肌源性损害.疑为横纹肌溶解症.停用拉米夫定及阿德福韦酯,肌酸激酶下降,肌无力症状好转.1年后,患者再次出现双下肢水肿并腹胀伴间断发热.肌酸激酶5546 U/L,肌红蛋白＞1200 μg/L,抗Jo-1抗体阳性.诊断:多发性肌炎,抗合成酶综合征.给予保肝、利尿、营养神经等治疗.2周后,加用恩替卡韦0.5 mg、1次/d抗病毒治疗.2个月后,给予糖皮质激素治疗.1个月后,患者四肢肌肉酸痛、无力症状基本缓解,复查肌酸激酶正常.
1례42세남성만성을형간염환자구복랍미부정(100 mg,1차/d)화아덕복위지(10 mg,1차/d)치료,약1개월후출현사지기육산통、핍력,쌍하지수종.실험실검사:기산격매9368 U/L,기홍단백＞4317 μg/L.기전도시우측삼각기기원성손해.의위횡문기용해증.정용랍미부정급아덕복위지,기산격매하강,기무력증상호전.1년후,환자재차출현쌍하지수종병복창반간단발열.기산격매5546 U/L,기홍단백＞1200 μg/L,항Jo-1항체양성.진단:다발성기염,항합성매종합정.급여보간、이뇨、영양신경등치료.2주후,가용은체잡위0.5 mg、1차/d항병독치료.2개월후,급여당피질격소치료.1개월후,환자사지기육산통、무력증상기본완해,복사기산격매정상.
A 42-year-old man with chronic hepatitis B was treated with combined use of lamivudine 100 mg once daily and adefovir dipivoxil 10 mg once daily.After a month the patient developed muscle aches in his extremities,asthenia and edema in his lower extremities.Laboratory tests showed that creatine kinase and myoglobin were 9368 U/L and ＞ 4317 μg/L,respectively.Electromyography indicated a myogenic lesion of right deltoid muscle.Rhabdomyolysis was suspected.Lamivudine and adefovir dipivoxil were stopped.The creatine kinase levels decreased and symptoms of muscular weakness improved.One year later,the patient had recurred edema in his lower extremities,abdominal distension and intermittent fever.Creatine kinase and myoglobin were 5546 U/L and ＞ 1200 μg/L,anti-Jo-1 antibody was positive.The patient was diagnosed with polymyositis and antisynthetase syndrome.He was given treatment with liverprotective,diuretics and neurotrophic agents.Two weeks later,he was given entecavir 0.5 mg once daily.Two months later,he was given glucocorticoid treatment.One month later,the muscle aches and asthenia improved,and his creatine kinase levels dropped to normal.