补充维生素D可以防止在替比夫定治疗乙肝炎患者的关节痛和

StephenW

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.

StephenW

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
A. Djibre3 2 N. Assy1，，Tzuker4 M.，S. Dabush1，T. Ali5，学阿布Mouch6。
1Liver单位，谢夫医学中心，采法特，2Liver单位，Technion工业研究所，
海法，谢夫医疗，5Ziv医疗3Ziv医疗中心，4Biochemistry
中心，Safed的，希勒尔Yafe 6Liver单位，医疗中心，以色列哈代拉，
电子邮件：assy.n ziv.health.gov.il
背景：替比夫定是一种核苷类似物，作为在以色列与慢性HBV感染患者的第一线治疗。据报道，在接受替比夫定治疗的患者肌肉病变及神经病变。维生素D已被证明，以提高测试的肌肉功能和肌纤维组成的影响。
目的：检查是否添加维生素D，以替比夫定治疗可以改善肌肉疼痛和无力的不良反应事件，防止的的肌酸Kinas（CK）升高。
方法：HBeAg阴性慢性乙型肝炎病毒感染患者30例（治疗组，年龄41±13岁，BMI 25±4，56％为男性，19阿拉伯人，犹太人9，和第2的俄罗斯血统）接受替比夫定：每日600mg加维生素D3（Vitamydine 2000 IU /天，滴（费）进行了比较谁收到替比夫定52周（历史对照，GLOBE试验NCT00057265）不含维生素D的每日600mg的历史对照组。在不同的评估标准生化的的肌酸kinas（CK）次随访过程中CK正常<170，1〜2级; 170-1190 3-4级> 7倍ULN）。对不良事件进行评估问卷。肌病被定义为持久性不明原因的肌肉酸痛，疼痛，或无力的增加在肌酸kinas（CK）水平的程度。
结果：所有患者均与D型，56％为男性。总体上看，经过1年的随访中，76％（23/30）维生素D3治疗组与正常CK，23％（7/30）1-2级CK升高并没有有3-4级CK海拔级1-2 CK海拔，与3-4级CK海拔的7.5％相比，8％
在历史对照组。 CPK海拔的平均时间为40周和范围在187-750 U / L，在第40周平均血清维生素D水平为41±30（NL> 32毫微克/毫升）。 2％的患者在治疗组相比，21％的历史和对照组（P <0.001），在临床上肌肉疼痛。
肌病是不存在的历史对照组相比，1例在治疗组。
结论：添加维生素D，以替比夫定治疗慢性HBV基因型D感染的患者，可能会显着

改善肌肉疼痛和预防的3-4级CK抬高。