阿德福韦酯致低磷性骨软化症2例临床分析.doc

小剂量阿德福韦酯导致低血磷性骨软化症两例并文献总结基金项目：上海市卫生系统优秀学科带头人新百人计划基金（课题编号： 基金项目：上海市卫生系统优秀学科带头人新百人计划基金（课题编号：XBR2011006） 上海市科委基础研究重大课题基金（课题编号：11DJ1400103） 作者单位：200433 上海长海医院风湿免疫科, E-mail：lingling0119@163.com 通信作者：赵东宝，E-mail： dongbaozhao@163.com 贺玲玲 庞亚飞 赵东宝* 【摘 要】 目的 分析小剂量阿德福韦酯（ADV）导致低血磷性骨软化症的临床特点、治疗及预后。方法 结合我院诊断的两例服用阿德福韦酯后发生低血磷性骨软化症患者资料和国内外文献，对该临床特点、治疗、预后和早期诊断进行总结。结果 服用小剂量阿德福韦酯治疗慢性乙型肝炎导致低血磷性骨软化症患者共12例，男9例，女3例，均来自亚洲人群，年龄在（22-74）岁，服用阿德福韦酯（18-64）月发现低血磷，血磷波动在（0.37-0.79）mmol/L，血钙正常或偏低，血钾偏低，且均有不同程度的骨质疏松，予补充钙剂、骨化三醇、欧思美等治疗预后良好。结论 小剂量阿德福韦酯所致低血磷性骨软化症临床相对少见，容易漏诊，凡服用阿德福韦酯的患者，无论剂量大小，均应定期检查血肌酐、血钙、血磷及骨密度，以监测是否发生肾损害及低血磷性骨软化症，以期早期诊断，一旦各项指标异常应立即停药，同时可换用其它抗病毒药，如干扰素、恩替卡韦等。 【关键词】 骨软化症；低血磷；阿德福韦酯 Two cases of small adefovir dipivoxil induced hypophophataemic osteomalacia and literature summary HE ling-ling* ，PANG ya-fei ，ZHAO dong-bao. *Department of Rheumatology and Immunology，Shanghai Changhai Hospital，Second Military Medical University Shanghai 200433，China Corresponding author：ZHAO dong-bao，Email：dongbaozhao@163.com 【Abstract】objective To analyze the clinical features，treatment and prognosis for hypophosphatemia osteomalacia related to the small dose of adefovir dipivoxil.Methods The combination of hypophosphatemia patients associated with taking adefovir dipivoxil and literature,to summarize the clinical features, treatment, prognosis and early diagnosis. Results Low-dose adefovir dipivoxil for chronic hepatitis B led to a total of 12 cases of hypophosphatemia，including 9 males and 3 females。They are all from the Asian population, age rang from 22 to 74 years old, hypophosphatemia were found after taking adefovir dipivoxil rang from 18 to 64 months.phosphorus fluctuations from 0.37 to 0.79 mmol/L, serum calcium is normal or low, potassium levels is low, and have varying degrees of osteoporosis. The prognosis is good when given calcium, calcitriol,strontium ranelate treatment.Conclusion The small dose of adefovir dipivoxil induced hypophosphatemia osteomalacia is rarely seen in clinical practice，Th