恩替卡韦导致乙型肝炎肝硬化患者周围神经病变临床特征*

目的总结乙型肝炎肝硬化患者服用恩替卡韦过程中出现周围神经病变的临床特征和处理经验。方法自2011年7月至2013年7月解放军第302医院收治3例服用恩替卡韦过程中出现周围神经病变的乙型肝炎肝硬化患者,对其周围神经病变的临床特征进行总结。采用荧光定量PCR法检测HBV DNA,采用化学发光法检测血清HBsAg和HBeAg、甲状腺功能、维生素B12、叶酸,采用间接免疫荧光法检测自身免疫抗体,采用ICP-MASS质谱分析法检测铅、镉等重金属,使用GE公司E9型超声仪检测四肢血管,使用丹麦维迪公司Keypoint型电生理仪检测神经传导速度和肌电图。结果3例患者均为中年男性,在服用恩替卡韦3天~52周出现周围神经病变,主要表现为四肢末端麻木、疼痛,神经传导速度减慢,肌电图检查均正常;3例患者均停用恩替卡韦,更换为阿德福韦酯抗病毒治疗,并给予B族维生素、复合辅酶、前列地尔、丹参等药物治疗和物理治疗,患者不适症状在1周~5周内恢复,神经传导速度在16~61周内恢复,随访期间未出现复发。结论恩替卡韦可以导致乙型肝炎肝硬化患者出现周围神经病变,临床表现各异。一旦发生,应做到及时停用可疑药物、个体化处理,预后较好。

Clinical observation of entecavir-induced peripheral neuropathy in three patients with HBV related liver cirrhosis

Objective To investigate the clinical characteristics and disposal experiences of entecavir-induced peripheral neuropathy in three patients with HBV related liver cirrhosis. Methods We had a retrospective analysis about peripheral neuropathy caused by using entecavir in three patients with HBV related liver cirrhosis in our hospital from July 2011 to July 2014. The clinical characteristics of peripheral neuropathy were summarized. The clinical index,serum HBV DNA and neuro-electromyography were routinely carried out. Results The three patients were middle-aged men,the symptoms of peripheral neuropathy appeared from 3 days to 52 weeks after entecavir administration. Numbness and pain in distal limbs were main clinical manifestations. Neuro-electromyography showed peripheral nerves were injured. Electromyogram were normal in the three patients. Entecavir were discontinued and adefovir were given in the three patients. Vitamin B,combined coenzyme, alprostadil,salvia miltiorrhiza and physical exercise were also carried out in this three patients. The symptoms of peripheral neuropathy disappeared 1 to 5 weeks after entecavir discontinuation and the function of peripheral nerves recovered 16 to 61 weeks later. During follow-up,the three patients were not showed recurrence. Conclusion Peripheral neuropathy can be caused by using entecavir in patients with HBV related liver cirrhosis. The clinical manifestation in each patient differs a little. When a patient like this is met,the discontinuation of suspected medicine is recommended and an appropriate treatment should be given. Then the patient would have a good prognosis.