阿德福韦酯致Fanconi综合征和低磷性骨软化症并进行性肌无力1例

Adefovir dipivoxil-induced Fanconi syndrome and hypophosphatemic osteomalacia associated with muscular weakness in a patient with chronic hepatitis B

阿德福韦酯是一种常用的治疗慢性乙型病毒性肝炎的药物。阿德福韦酯的肾毒性具有剂量和时间相关性,多见于30 mg/d以上剂量以及有基础肾功能损害的患者。我们报道1例慢性乙肝患者,服用阿德福韦酯10 mg/d共4年,以腰骶部和膝、髋关节疼痛为主诉就诊,曾辗转多家医院均误诊为强直性脊柱炎或脊柱关节病,最终确诊为获得性Fanconi综合征和低磷性骨软化症伴进行性肌无力,查阅国内外文献,类似报道不足10例,阿德福韦酯的肾损害应引起临床医师的重视。

Adefovir dipivoxil is commonly used for treatment of chronic hepatitis B.The renal toxicity of adefovir dipivoxil is dose-and time-related,occurring often in patients with a daily dose over 30 mg and those with impaired renal function.We report a case of chronic hepatitis B with a history of taking adefovir dipivoxil at 10 mg/day for 4 years.The patient complained of lumbosacral and joint pain and had the diagnosis of ankylosing spondylitis（AS） or spondyloarthropathy in several hospitals before admission in our hospital.A diagnosis of acquired Fanconi syndrome and hypophosphatemia osteomalacia associated with progressive muscular weakness was made eventually.We reviewed the literature and found reports of only fewer than 10 similar cases.Clinical attention should be given to kidney damage induced by adefovir dipivoxil.