阿德福韦酯致低磷性骨软化症1例及文献回顾  

Hypophosphatemic osteomalacia caused by adefovir dipivoxil: a case report and literature review

作　　者：郎江莉 朱思忆 余希杰[1] LANG Jiang-li1 , ZHU Si-yi2, YU Xi-jie1(1. Laboratory of Endocrinology and Metabolism, Department of Endocrinology and Metabolism, State Key Laboratory of Biotherapy , West China Hospital, Sichuan University, Chengdu 610041, China; 2. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, Chin)

机构地区：[1]四川大学华西医院内分泌代谢科/内分泌与代谢病研究室,成都610041 [2]四川大学华西医院康复医学中心,成都610041

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2018年第2期186-192,共7页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金(81370969;81572639;81770875);高等学校博士学科点专项科研基金(20130181110066);成都市科学技术局基金(2014-HM01-00382-SF)

摘　　要：目的探讨阿德福韦酯(adefovir dipivoxil,ADV)所致低磷性骨软化症的临床特征、发病机制及早期诊断。方法对1例口服ADV导致的低磷性骨软化症患者的临床资料进行分析及文献回顾。随访观察该患者停药后的临床资料。结果 58岁女性患者因"双足跟疼痛14个月,双下肢、胸骨疼痛4个月"于2016年3月就诊。2010年7月患者因乙肝病毒感染口服拉米夫定(100 mg/d)和ADV(10 mg/d)治疗。用药期间出现足跟、下肢及胸骨疼痛,影像学检查提示骨质疏松、跟骨和股骨上段骨折。2015年4月和11月肝功能检查均发现碱性磷酸酶(alkaline phosphatase,ALP)升高。2016年1月发现血磷(0.23 mmol/L)和25羟维生素D(39.11 nmol/L)降低,停用ADV。2016年3月就诊于四川大学华西医院内分泌科后予补充骨化三醇及钙治疗。2016年6月X线示双侧股骨上段假骨折线消失。随访复查血磷(0.94 mmol/L)和ALP恢复正常。结论 ADV导致的低磷性骨软化症易被漏诊或误诊为骨质疏松症(osteoporosis,OP)、骨肿瘤及强直性脊柱炎。检查电解质能及时发现低磷血症,其他肝功能指标正常时ALP升高需引起注意。血清胱抑素C、尿β2微球蛋白和尿α1微球蛋白有助于早期发现ADV导致的肾损伤。Objective To analyze clinical characteristics, pathogenesis, and early diagnosis of hypophosphatemic osteomalacia caused by adefovir dipivoxil （ ADV）. Methods We reported the clinical data of one patient with hypophosphatemic osteomalacia induced by ADV and retrospectively analyzed the literatures. We also collected clinical data of this patient after withdrawal of ADV. Results A 58-year-old woman visited hospital in March 2016 because of bone pain in heels within the past fourteen months and pain of lower limbs and sternum in the past 4 months. She took lamivudine （ 100 mg/d） and ADV （ 10 mg/d） from July 2010 to treat chronic hepatitis B virus infection. She had pains at heels, lower limbs, and sternum during the treatment. Image examination showed osteoporosis along with fracture of calcaneus and proximal femur. In April and November 2015, she rechecked her liver functions and found levels of alkaline phosphatase （ALP） were increased. In January 2016, she withdrew ADV because the laboratory data showed decreased serum phosphate （0.23 retool/L） and 25-hydroxyvitamin D （39. 11 nmol/L）. In March 2016, she visited West China Hospital and was supplemented with caleitriol and calcium. X-ray in June 2016 showed looser zone disappeared. Finally, serum phosphate increased to 0.94 mmol/L and level of AI,P decreased to normal. Conclusions Hypophosphatemic osteomalacia induced by ADV is easily misdiaguused as osteoporosis, bone tumor or spondyloarthritis. We shouht pay attention to ALP and electrolyte, especially serum phosphate. Serum cystatin C, urine 132-microglnbulin, and urine α1-microglnbulin are helpful for early diagnosis of kidney injury induced by ADV.

关 键 词：阿德福韦酯 低磷性骨软化 骨质疏松症 骨折 

分 类 号：R681[医药卫生—骨科学]