阿德福韦酯致Fanconi综合征并继发低磷性骨软化症4例

 目的  探讨阿德福韦酯相关性Fanconi综合征继发低磷性骨软化症的临床特点。方法  报道4例阿德福韦酯相关性Fanconi综合征继发低磷性骨软化症,并进行相关文献复习,总结其临床特点。结果  4例患者均表现为不同程度骨关节疼痛、肌无力,既往乙肝病史,服用阿德福韦酯抗病毒治疗3~6年不等,血液检查示低血磷,同时合并不同程度低血钾、低血尿酸,尿检示糖尿及蛋白尿,诊断为阿德福韦酯相关性Fanconi综合征并继发低磷性骨软化症。复习文献发现,阿德福韦酯治疗所致Fanconi综合征继发低磷性骨软化症有剂量、时间依赖性及可逆性特点,应用小剂量阿德福韦酯(10 mg/d)后出现Fanconi综合征多见于亚裔男性。患者常因骨关节疼痛起病,首诊科室多为骨科及风湿科,确诊周期长,易漏诊、误诊。结论  凡服用阿德福韦酯的患者,无论剂量大小,均应定期进行相关检查,如血钙、血磷、尿常规与尿生化等,以监测是否发生Fanconi综合征并继发低磷性骨软化症。

Hypophosphataemic osteomalacia in the context of Fanconi′s syndrome secondary to adefovir therapy:4 cases report and literature review

Objective  To investigate the clinical features for the hypophosphataemic osteomalacia in the context of Fanconi′s syndrome secondary to adefovir dipivoxil.Methods  Analysis was made upon 4 cases of patients with chronic hepatitis B developed hypohosphataemic osteomalacia after administration of adefovir dipivoxil.Literature review was carried out to survey the features of hypophosphataemic osteomalacia after administration of adefovir dipivoxil among patients with chronic hepatitis B.Results  Four male patients presented generalised bone pain,muscle weakness after taking adefovir antiviral therapy 3-6 years.Laboratory investigation results performance outstantding in hypophosphataemia,hypokalemia,low blood uric acid,glycosuria and proteinuria.The literature review found that this type of hypophosphataemic osteomalacia was dose dependent,time dependent and reversible,and hypophosphataemic osteomalacia caused by a small dose of adefovir dipivoxil (10 mg/d) occurred more often in Asian men.As it′s often onset with bone and joint pain,patients are more likely to go to the orthopedics,nephrology department and rheumatology department,cause misdiagnosis and to takes a long period to diagnose.Conclusions  Patients with chronic hepatitis B who take adefovir dipivoxil,no matter dosages,should take regular examinations including blood calcium and serium inorganic phosphorus to monitor whether hypophosphataemic osteomalacia occurs.