长期服用低剂量阿德福韦酯致低磷性骨软化症:病例报道与文献复习

Hypophosphoric osteomalacia induced by long-term and low-dose oral adefovir dipivoxil:one case report and literatures review

本文回顾性分析1例长期服用低剂量阿德福韦酯致低磷性骨软化症的慢性乙型肝炎患者的诊疗情况并复习相关文献。该患者以无明显诱因逐渐出现腰痛伴双下肢无力为首发症状,曾服用阿德福韦酯(10 mg/d)6年余。辅助检查见低血磷、高碱性磷酸酶、肾性糖尿等,表现为近端肾小管功能异常。结合既往用药史,考虑为阿德福韦酯所致肾损害,更换阿德福韦酯为恩替卡韦分散片,并予以补钾、磷、骨化三醇等治疗,疼痛较前明显缓解,血磷、尿糖等生化指标见好转。总结其诊治经验并复习相关文献,供临床医生参考。

The diagnostic and therapeutic experiences of one chronic hepatitis B patient with hypophosphoric osteomalacia induced by low dosage oral adefovir dipivoxil for a long term were retrospectively analyzed.The patient primarily complained lumbago with gradual bilateral lower limb weakness.The patient had a history of a low dose adefovir dipivoxil orally for 6 years(10 mg/d),and manifested low blood phosphorus,high alkaline phosphatase and renal glycosuria,and abnormal function of proximal renal tubules in the examination.In view of previous medication history,adefovir dipivoxil was considered to be the cause of renal damage.Adefovir dipivoxil was replaced by entecavir dispersive tablets,and potassium,phosphorus,ossified triglyceride and other treatments were given.After that,the painful symptoms were obviously relieved and the indexes of blood phosphorus and renal glycosuria improved significantly.The experience of diagnosis and treatment for the patient were summarized and the relevant literatures were reviewed for the reference of clinicians.