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本帖最后由 StephenW 于 2012-9-29 12:47 编辑
补充维生素D可以防止在替比夫定治疗慢性乙型肝炎患者的关节痛和提升CPK
http://download.journals.elsevierhealth.com/pdfs/journals/0168-8278/PIIS0168827811607071.pdf
VITAMIN D SUPPLEMENT PREVENTS MYALGIA AND ELEVATION OF CPK IN CHRONIC HEPATITIS B PATIENTS TREATED WITH TELBIVUDINE
N. Assy1,2, A. Djibre3, M. Tzuker4, S. Dabush1, T. Ali5, S. Abu Mouch6.
1Liver Unit, Ziv Medical Center, Safed, 2Liver Unit, Technion Institute,
Haifa, 3Ziv Medical Center, 4Biochemistry, 5Ziv Medical, Ziv Medical
Center, Safed, 6Liver Unit, Hillel Yafe Medical Center, Hadera, Israel
E-mail: [email protected]
Background: Telbivudine is a nucleoside analog used as first line therapy in patients with chronic HBV infection in Israel. Myopathy and neuropathy have been reported in patients who received telbivudine treatment. Vitamin D has been shown to improve test of muscle function and impact on muscle fiber composition.
Aim: To examine whether adding vitamin D to telbivudine therapy could improve adverse events of muscle pain and weakness and prevent Creatine Kinas (CK) elevation.
Methods: 30 patients with HBeAg negative chronic HBV infection (treatment group, age 41±13 yrs, BMI 25±4, 56% male; 19 Arabs, 9 Jewish, and 2 of Russian descent) received telbivudine 600mg daily plus vitamin D3 (Vitamydine drops (Fischer), 2000 IU/d, were compared to the historical control group who received telbivudine 600mg daily without vitamin D for 52 weeks (Historical controls, GLOBE trial- NCT00057265). Creatine kinas (CK) was assessed by standard biochemistry at various times during follow up. CK Normal <170, grade 1–2; 170–1190, grade 3–4 >7X ULN). Adverse events were assessed by questionnaire. Myopathy was defined as persistent unexplained muscle aches, pain, or weakness regardless of the degree of increases in creatine kinas (CK) levels.
Results: All patients were with genotype D, and 56% were male. Overall, after 1 year of follow up, 76% (23/30) of the treatment group with vitamin D3 had normal CK, 23% (7/30) had grade 1–2 CK elevation and none had grade 3–4 CK elevation as compared to 8% with Grade1–2 CK elevation and 7.5% with Grade 3–4 CK elevation
in the historical controls group. The mean time to CPK elevation was 40 weeks and ranges between 187–750 U/L. Mean vitamin D serum level at week 40 was 41±30 (NL > 32 ng/ml). 2% of patients in the treatment group had muscle pain as compared to 21% in the historical control group and in a clinical setting (P < 0.001).
Myopathy was absent in the treatment group as compared to 1 patient in the historical controls.
Conclusion: Adding vitamin D to Telbivudine therapy for patients with chronic HBV genotype D infection may significantly improves muscle pain and prevent grade 3–4 CK elevation.
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