Fatal liver failure due to reactivation of lamivudine-resistant HBV mutant
Fatal liver failure due to reactivation of lamivudine-resistant HBV mutant
复制标题
DOI：
10.3748/wjg.v10.i11.1686
复制
发表时间：
2004-06-01
影响因子：
4.3
通讯作者：
Mine, Tetsuya
中科院分区：
文献类型：
--
作者：
Kagawa, Tatehiro;Watanabe, Norihito;Mine, Tetsuya
我们报告一例由于拉米夫定耐药HBV再激活而导致的致命性肝功能衰竭。自1998年以来，对一名53岁男性进行了HBV相关慢性肝炎随访。血清HBV-DNA为150 MEq/mL（分支DNA信号放大试验），ALT水平在50-200 IU/L之间波动，无肝硬化临床体征。拉米夫定（100 mg/d）开始于2001年5月，血清HBV-DNA随后下降到检测不到的水平以下。2002年5月，血清HBV-DNA升高至410 MEq/mL，沿着ALT升高（226 IU/L）。DNA聚合酶基因中的YMDD基序被YIDD取代。继续使用拉米夫定，ALT自发下降至之前的水平。10月3日，患者因全身乏力、恶心和黄疸入院。实验室数据显示HBV再激活和肝功能衰竭（ALT：1828 IU/L，总胆红素：10 mg/dL，凝血酶原INR：3.24）。出于宗教原因，患者及其家属拒绝输血、血浆置换和肝移植。患者入院后10 d死亡。尸检显示肝脏明显萎缩。
We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.