阿德福韦酯致低磷性骨软化症

Adefovir dipivoxil-induced hypophosphatemic osteomalacia

1例50岁男性患者因慢性乙型肝炎接受阿德福韦酯(10 mg/d)治疗。7年后患者出现全身多处骨痛,逐渐加重,活动受限。经X线、CT和磁共振检查发现左侧第8肋、右侧第7肋中段陈旧性骨折,右股骨颈骨折。实验室检查发现血肌酐111μmol/L,血磷0.41 mmol/L,碱性磷酸酶216 U/L。骨密度检查示第1~4腰椎、股骨颈和全髋骨骨质疏松。诊断为阿德福韦酯导致的低磷性骨软化症,停用阿德福韦酯,改用恩替卡韦,同时给予口服补磷。2个月后复查,患者症状改善;6个月后,患者骨痛基本消失,碱性磷酸酶、血肌酐和血磷均恢复正常。

A 50-year-old male patient was treated with adefovir dipivoxil 10 mg/d once daily for chronic hepatitis B.Seven years later,the patient developed multiple bone pains all over the body,which were gradually aggravated and restricted his movements.X-ray,CT,and magnetic resonance imaging examinations showed old fractures of the left 8th rib and the right 7th rib and fracture of the right femoral neck.Laboratory tests showed that serum creatinine was 111μmol/L,serum phosphorus was 0.41 mmol/L,and alkaline phosphatase was 216 U/L.Bone mineral density examination showed osteoporosis in the 1st to 4th lumbar vertebrae,femoral necks,and total hipbones.Adefovir dipivoxil-induced hypophosphatemia was diagnosed.Adefovir dipivoxil was discontinued and replaced by entecavir,and oral phosphorus supplementation was given.After 2 months of treatments,the patient′s symptoms were improved.After 6 months of treatments,the bone pain basically disappeared and alkaline phosphatase,serum creatinine,and phosphorus returned to normal.