阿德福韦酯致低血磷性骨软化症二例诊治分析

Adefovir Dipivoxil Induced Hypophosphatemic Osteomalacia:Report of Two Cases

目的探讨长期服用小剂量阿德福韦酯(10 mg/d)所致低血磷性骨软化症的临床特点,提高临床医生的认识。方法对我院2011年收治的2例慢性乙型肝炎长期服用小剂量阿德福韦酯(10 mg/d)导致的低血磷性骨软化症患者进行分析,并结合国内外相关文献进行复习。结果本组2例患者分别服用小剂量阿德福韦酯(10 mg/d)4年和6年,均在服药3年后出现全身骨痛、活动困难等症状,实验室检查示血磷水平下降,碱性磷酸酶水平增高,停用阿德福韦酯后予以补充活性维生素D和钙剂,治疗后患者临床症状改善,血磷水平恢复正常。结论阿德福韦酯具有肾毒性,其毒性与剂量及用药时间呈正相关;长期服用可导致低血磷性骨软化症,临床医生需提高认识,及早处理。

Objective To investigate clinical manifestations, treatment and prognosis of adefovir dipivoxil （ADV） induced hypophosphatemic osteomalacia. Methods Data of 2 chronic hepatitis B patients who developed hypophosphatemic osteo- malacia after long - term administration of ADV （ 10 mg/d） were analyzed and pertinent literatures at home and abroad re- viewed. Results The 2 patients administrated a low dose of ADV for 4, 6 years, respectively. Both developed generalized bone pain, difficult movement and other symptoms after 3 years of administration. By laboratory examination, serum phosphate level decreased, alkaline phosphatase increased. The clinical symptoms improved after supplement of active vitamin D and calcium, serum phosphate returned to normal. Conclusion ADV has nephrotoxicity, which is positively correlated with doses and medica- tion time. Long- term administration can lead to hypophosphatemic osteomalacia-