阿德福韦酯致低磷骨软化伴多发骨折2例并文献复习

发布时间：2018-04-25 09:18

  本文选题：阿德福韦酯 + 低磷血症　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨阿德福韦酯致低磷骨软化伴多发骨折的临床特点和治疗方法,有助于该疾病的早期诊断和正确治疗,减少患者痛苦。方法:回顾性分析2015、2017年在浙江大学附属第二医院内分泌科住院治疗的2例阿德福韦酯致低磷骨软化患者的临床病史、实验室检查、影像学资料、治疗方法、治疗效果,并复习相关文献资料。结果:2例患者长期服用10mg/天阿德福韦酯抗病毒治疗,均因骨痛伴活动障碍就诊,血液检查以低血磷、高碱性磷酸酶为突出表现,合并不同程度低尿酸血症,尿液检查发现尿磷、葡萄糖、蛋白、尿酸排泄增加,骨密度显示骨量减低,结合病史及辅助检查诊断为阿德福韦酯继发的低磷骨软化。更换抗病毒药物,中性磷制剂补磷、补充活性维生素D及补钙治疗后疼痛逐渐缓解,血磷回复至正常水平。结论:长期小剂量阿德福韦酯抗病毒治疗可导致Fanconi综合征,进一步引起低磷骨软化。长期服用阿德福韦酯的患者应定期检测血磷,出现骨痛、乏力等症状应及时就诊。
[Abstract]:Objective: to investigate the clinical characteristics and treatment of low phosphorus osteomalacia associated with multiple fractures caused by adefovir ester, which is helpful to the early diagnosis and correct treatment of the disease and reduce the pain of the patients. Methods: the clinical history, laboratory examination, imaging data, treatment methods and therapeutic effects of 2 patients with low phosphorus osteomalacia induced by adefovir were retrospectively analyzed in the Department of Endocrinology, second affiliated Hospital of Zhejiang University in 2015 and 2017. And review the relevant literature. Results two patients were treated with antiviral therapy of 10mg/ day adefovir ester for a long time, all of them were treated with bone pain and dyskinesia. The blood examination showed low blood phosphorus and high alkaline phosphatase, combined with different degree of hypouricemia. Urine examination found urine phosphorus. Glucose, protein, uric acid excretion increased, bone mineral density (BMD) decreased, combined with history and auxiliary examination of the diagnosis of adefovir dipivoxil secondary low phosphorus osteomalacia. After replacement of antiviral drugs, supplementation of phosphorus with neutral phosphorus, the pain was gradually alleviated after supplementation of active vitamin D and calcium, and blood phosphorus returned to normal level. Conclusion: long-term low-dose adefovir ester antiviral therapy can lead to Fanconi syndrome and further low-phosphorus osteomalacia. Patients who take adefovir should regularly detect blood phosphorus, bone pain, fatigue and other symptoms.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R68
，

本文编号：1800706