阿德福韦酯致低血磷性骨软化症2例分析

发布时间：2018-01-30 03:30

本文关键词： 阿德福韦酯骨软化症低磷血症骨质疏松　出处：《中国骨质疏松杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨长期服用小剂量阿德福韦酯导致低血磷性骨软化症的临床特点。方法对大连大学附属中山医院2015年2月至6月收治的2例长期口服阿德福韦酯(10 mg/d)导致低血磷性骨软化症患者的临床资料进行回顾性病例分析。结果2例患者分别为75岁男性和79岁女性,均因全身骨痛、肌肉无力和行走困难2年就诊,既往均有慢性乙型肝炎病史,分别口服阿德福韦酯(10 mg/d)8年和4年;化验提示低磷血症(男患为0.44 mmol/L,女患为0.47 mmol/L),低钾血症(男患为3.0mmol/L,女患为3.1 mmol/L),血碱性磷酸酶升高(男患为227 IU/L,女患为566 IU/L),25(OH)D降低(男患为18.16 ng/ml,女患为3 ng/ml),尿常规检测提示尿蛋白及尿糖为阳性,骨密度均提示骨质疏松,影像学显示多发性骨折。停服阿德福韦酯,补充钙剂、骨化三醇、氯化钾和中性磷溶液等治疗,患者生化指标逐渐恢复正常,骨痛及肌肉无力减轻,行走较正常。结论长期服用小剂量阿德福韦酯可以导致低血磷性骨软化症,应定期监测血电解质、肾脏功能、尿常规及骨密度,一旦出现阿德福韦酯相关的肾损伤,应停用阿德福韦酯,并纠正电解质紊乱,以避免引起低血磷性骨软化症。
[Abstract]:Objective to investigate the clinical characteristics of low blood phosphorus osteomalacia caused by long-term low-dose adefovir dipivoxil. Methods two cases of long-term oral adefovir were treated in Zhongshan Hospital affiliated to Dalian University from February 2015 to June. The clinical data of patients with low blood phosphorus osteomalacia caused by 10 mg / d were analyzed retrospectively. Results the two patients were 75 years old male and 79 years old female. All patients were treated for 2 years because of systemic bone pain, muscular weakness and walking difficulty. All patients had a history of chronic hepatitis B. They took adefovir ester 10 mg / d for 8 years and 4 years respectively. Tests showed hypophosphatemia (0.44 mmol / L in men, 0.47 mmol / L in women) and hypokalemia (3.0 mmol / L in men). It was 3.1 mmol / L in women and elevated in serum alkaline phosphatase (227 IU / L in males and 566 IUP / L in females). 25% OHH D was decreased (18.16 ng / ml in male and 3 ng / ml in female). Urine routine examination showed that urine protein and urine sugar were positive, and bone mineral density (BMD) indicated osteoporosis. Radiographically showed multiple fractures. After taking adefovir ester, calcium supplement, ossification triol, potassium chloride and neutral phosphorus solution, the biochemical parameters of the patients gradually recovered to normal, bone pain and muscle weakness were alleviated. Conclusion Low-dose adefovir can lead to low blood phosphorus osteomalacia. Blood electrolyte renal function urine routine and bone mineral density should be monitored regularly. In the event of renal injury associated with adefovir, adefovir should be discontinued and electrolyte disorders corrected to avoid hypoglycemic osteomalacia.
【作者单位】：遵义医学院研究生院;大连大学附属中山医院骨质疏松科;
【分类号】：R681
【正文快照】： 阿德福韦酯于2005年在中国上市后广泛用于治疗慢性乙型肝炎,它通过抑制乙肝病毒DNA复制而发挥抗病毒作用。研究表明,长期应用大剂量阿德福韦酯可引起肾损伤[1],近来有报道长期小剂量阿德福韦酯也可导致肾损害,引起低血磷性骨软化症。大连大学附属中山医院于2015年2月和6月收治

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