阿德福韦酯致肾小管损害继发低磷软骨症5例并文献分析

Hypophosphatemic osteomalacia secondary to renal tubular damage induced by adefovir: report of five cases and literature review

目的探讨阿德福韦酯（10 mg/d）长期治疗慢性乙肝患者引起肾小管损害继发低磷软骨症的临床特点、治疗方法及预后。方法回顾性分析2011年11月至2013年11月我院内分泌科收治的5例阿德福韦酯致肾小管损害继发低磷软骨症患者的临床表现、实验室检查、影像学检查、治疗方案以及随访情况,并通过检索Pub M ed、中国知网全文数据库,结合相关文献报道病例进行比较分析。结果我院5例患者的临床表现主要为骨痛进行性加重;实验室检查主要为低血磷、高尿磷、高碱性磷酸酶（ALP）、低血钙。治疗方法：5例患者停用阿德福韦酯,加用碳酸钙D3及骨化三醇,4例给予补充中性磷溶液,2∽8个月血磷正常,骨痛缓解。结论低剂量阿德福韦酯会引起低磷软骨症,建议长期用药的患者定期监测尿酸、肾小球滤过率（e GFR）、ALP、血磷、尿常规等,服药期间一旦出现不明原因的骨痛也应及时就医,以便尽早确诊,尽早停药治疗并对症处理。

Objective To investigate the clinical features,treatment and prognosis of hypophosphatemic osteomalacia secondary to renal tubular damage induced by adefovir（ 10 mg / d）. Methods The clinical data of 5 cases of hypophosphatemic osteomalacia induced by adefovir diagnosed in our hospital from November 2011 to November 2013 w as analyzed retrospectively,and the related literatures in recent years w ere retrieved from Pub Med,CNKI. The related data of the cases from our hospital and the literatures w ere compared and analyzed. Results The main clinical menifestations included progressive bone pain,and the laboratory tests mainly revealed hypophosphatemia,hyperphosphaturia,elevated serum alkaline phosphatase（ ALP） level and hypocalcemia. Five cases stopped taking adefovir and adminstrated calcium carbonate D3 and calcitrol. Four cases w ere given a neutal phosphate,the serum phosphorus recovered at 2 ∽8 months after treatment,and the bone pain w as relieved. Conclusion Low dose adefovir dipivoxil can induce hypophosphatemic osteomalacia. The uric acid,rate of glomerular filtration（ e GFR）,ALP,serum phosphorus and routine urine test should be monitored in patients w ho took long term adefovir dipivoxil regularly. Patients should seek medical advice timely once the unexplained bone pain appeared during the medication,so that the diagnosis,w ithdraw al and symptomatic treatment w ould be taken.