全胃切除术后维生素D缺乏性骨软化症一例  

Osteomalacia caused by vitamin D deficiency after gastrectomy: a case report

作　　者：滕若凌 谈波宇 刘华[2] 杨玉娇 刘芬芬 刘萍 王龙[1] 张剑[3] 朱禛 王建锋[4] 庞聪[5] 张翠萍 傅琪 向莉[2] 丁怡[1] TENG Ruo-ling;TAN Bo-yu;LIU Hua;YANG Yu-jiao;LIU Fen-fen;LIU Ping;WANG Long;ZHANG Jian;ZHU Zhen;WANG Jian-feng;PANG Cong;ZHANG Cui-ping;FU Qi;XIANG Li;DING Yi(Department of Geriatrics,the First People's Hospital of Changzhou,Changzhou 213003,Jiangsu,China;Department of Nephrology,the First People's Hospital of Changzhou,Changzhou 213003,Jiangsu,China;Department of Ultrasonics,the First People's Hospital of Changzhou,Changzhou 213003,Jiangsu,China;Department of Nuclear Medicine,the First People's Hospital of Changzhou,Changzhou 213003,Jiangsu,China;Department of Radiology,the First People's Hospital of Changzhou,Changzhou 213003,Jiangsu,China)

机构地区：[1]常州市第一人民医院老年医学科,江苏常州213000 [2]常州市第一人民医院肾内科,江苏常州213000 [3]常州市第一人民医院超声医学科,江苏常州213000 [4]常州市第一人民医院核医学科,江苏常州213000 [5]常州市第一人民医院医学影像科,江苏常州213000

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2023年第4期362-366,共5页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：江苏省卫生健康委员会老年健康科研课题(LK2021040);江苏省老年医学临床技术应用研究项目(LD2022008);江苏省常州市科学技术局应用基础研究(CJ20210140)。

摘　　要：全胃切除术导致维生素D缺乏性骨软化症临床少见,易被误诊、误治。本文报道1例65岁老年女性,以全身骨痛就诊。5年前因贲门癌行全胃切除术,术后长期腹泻。入院后完善实验室检查示低血钙、低血磷、维生素D缺乏、甲状旁腺激素升高、骨吸收及骨形成指标升高,同时合并代谢性酸中毒。尿电解质示低尿钙和低尿磷。影像学示肋骨及骨盆多处骨皮质不连续。经长期维生素D、钙剂等治疗,临床症状和实验室指标在治疗开始时恶化,但随访1年后明显改善。本文在复习相关文献的基础上,探讨胃切除术后骨软化症的发病机制与治疗方法,尤其是大剂量维生素D的用药经验。Osteomalacia caused by vitamin D deficiency after gastrectomy is rare and easily misdiagnosed.A 65-year-old woman was admitted complaining of severe bone pain.She underwent total gastrectomy due to gastric cancer at the age of 60 and suffered from chronic diarrhea after surgery.Laboratory tests revealed hypocalcemia,hypophosphatemia,vitamin D deficiency,high parathyroid hormone level,elevated biochemical markers of bone turnover,together with metabolic acidosis.Urinary electrolytes revealed low level of urinary calcium and low urinary phosphorus.Imaging examinations showed multiple cortical discontinuities in the ribs and pelvis.After long-term treatment with vitamin D and calcium,clinical symptoms and laboratory indicators were worsened at the beginning of treatment but significantly improved after 1 year of follow-up.Based on the review of relevant literature,we discussed the pathogenesis and treatment of osteomalacia after gastrectomy and the therapy experience of high-dose vitamin D.

关 键 词：骨软化症 维生素D缺乏 胃切除术 大剂量维生素D 

分 类 号：R589[医药卫生—内分泌] R681[医药卫生—内科学]