摘要
目的探讨阿德福韦酯导致的低血磷性骨软化症的临床特征、治疗方案及转归。方法对1例慢性乙型肝炎患者服用阿德福韦酯后发生的低血磷性骨软化症进行分析，并就其在全世界慢性乙型肝炎患者中的发生情况做相关文献复习。结果本例患者的临床症状出现时间与服用阿德福韦酯时间平行，在停用阿德福韦酯并补充中性磷后，临床症状减轻，血磷恢复正常（症状较重时0．77mmol／L，停用阿德福韦酯10周时升至0．98mmol／L），诊断为阿德福韦酯相关低血磷性骨软化症。复习文献发现阿德福韦酯导致的尿磷排泄增多存在剂量依赖性、时间依赖性、可逆性，而小剂量阿德福韦酯（10mg／d）治疗慢性乙型肝炎后出现低血磷性骨软化症的报道均来自亚裔人群。结论阿德福韦酯导致的低血磷性骨软化症为罕见疾病。凡因乙型肝炎服用阿德福韦酯的患者，无论剂量大小，均应定期进行相关检查，如血钙、血磷，以监测是否发生低血磷性骨软化，一旦发生，可换用其他抗病毒药物。
Objective To investigate the clinical features and treatment protocol and prognosis for the hypophosphataemic osteomalacia related to adefovir dipivoxil. Methods Analysis was made upon a case of patient with chronic hepatitis B developed hypophosphataemic osteomalacia after administration of adefovir dipivoxil. Literature review was carried out to survey the global prevalence of hypophosphataemic osteomalacia after administration of adefovir dipivoxil among patients with chronic hepatitis B. Results The clinical symptoms started paralleling to the time taking adefovir dipivoxil, and alleviated after the patient withdrawn adefovir dipivoxil 10 weeks and was given phosphorus. Meanwhile, serum inorganic phosphorus recovered to normal （0.98 mmol/L） , which lowest level was 0.77 mmol/L. Systematic review of the literature showed that hyperphosphaturia related to adefovir dipivoxil was dose-dependent, time-dependent and reversible. All reported cases of hypophosphataemic osteomalacia secondary to adefovir dipivoxil （ 10 mg/d） were from Asian population. Conclusions Adefovir dipivoxil induced hypophosphataemic osteomalacia is rarely seen in clinical practice. Those patients with chronic hepatitis B who take adefovir dipivoxil, no matter dosages, should take periodical examinations including blood calcium and serium inorganic phosphorus to monitor whether hypophosphataemic osteomalacia occurs. Other anti-virus drugs could be used when it happens.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2011年第9期754-757,共4页
Chinese Journal of Internal Medicine
关键词
骨软化症
低血磷性
阿德福韦酯
Hypophosphataemic osteomalacia
Adefovir dipivoxil
