疑似Telbivudine引起肌肉病變之案例報告

A Case of Suspected Telbivudine-Induced Myopathy

B 型肝炎病毒（HBV）感染是一個重要的全球性健康問題，在全球60 億人口中，估計大約有3.5億人為B型肝炎帶原者。而其中大約有15％至40％的HBV帶原者會發展為肝硬化、肝衰竭及肝癌，每年預估因為B型肝炎相關併發症導致死亡人數約為50萬人。目前治療慢性B 型肝炎的口服藥物皆為nucleoside/nucleotide analogs，包括：lamivudine、adefovir、entecavir、telbivudine 及tenofovir。Telbivudine屬於thymidine nucleoside analog，為FDA 於2006 年10 月核准上市藥品，而國內於2007年核准上市。藥物安全性問題有3 至4 級血清肌酸激酶（creatinine kinase, CK）值上升及肌肉病變（myopathy），而肌肉病變主要會發生在四肢部位，且會伴隨全身虛弱情形。本案例為41歲男性，本身為B型肝炎帶原者，使用telbivudine 7 個月後開始出現全身疼痛及肌痛情形，11個月後檢查發現CK值上升，經住院治療及停藥處置後CK 值降低。經由文獻搜尋目前國內並無案例報告，期望經由此案例，提醒臨床醫師在使用藥品時，必須告知病患注意是否出現相關症狀，以利及早診斷。

Hepatitis B virus (HBV) infection is an important global health issue. Approximately 3.5 billion people have been infected with hepatitis B. About 15% to 40% of HBV carriers will develop cirrhosis, liver failure and liver cancer. Therefore, approximately 50 million people each year died due to hepatitis B related complications. The chronic hepatitis B oral treatment are nucleoside/nucleotide analogs, include lamivudine, adefovir, entecavir, telbivudine and tenofovir. Telbivudine is a thymidine nucleoside analog, which was approved by the US Food and Drug Administration in Oct. 2006 and Taiwan in 2007. The medication safety issues include Grade 3 and 4 serum creatine kinase elevated and myopathy. Most of myopathy developed over limb and generally companied with weakness. This case report was a 41-year-old male administered telbivudine for hepatitis B. After 7 months of telbivudine treatment, he had myalgia with elevated creatine kinase. After discontinuing the drug and hospitalization, his creatine kinase was decreased. Based on this case report, we hope to remind clinicians to inform patient regarding the relevant symptoms while taking this drug.