阿德福韦酯致低磷骨软化症的6 例报道和病机探讨

目的：通过对6例服用阿德福韦酯后出现低磷骨软化患者的病情进展报告和中医证候分析,以中医“肝肾同源”理论探讨抗病毒药物所致肾损伤及骨软化症的病机及防治方法。方法：本研究对临床收治的6例无血缘关系的慢性乙肝患者,在接受阿德福韦酯治疗后出现了低磷骨软化症进行报道。同时对所有患者进行了中医症候分析。考虑低磷骨软化的发生与阿德福韦酯有关,故对抗病毒药物治疗肝炎后出现肾损伤及骨软化症的病情进展及预后进行分析,并进行文献回顾,对阿德福韦导致肾小管损伤的病机进行归纳。结合该病的中医证候进行结合分析,根据中医“肝肾同源”理论,及内经“肾主骨”的病机特点进行中医病机分析。结果：6例患者均为接受了阿德福韦酯10 mg天治疗48-84月后出现了低磷骨软化。每例患者均出现了骨密度的下降,血磷降低、碱性磷酸酶增高及不同程度的骨折影像学表现,且舌脉及中医证候分型为“肝肾亏虚”型,同时伴有“气滞血瘀”。我科拟诊“低磷骨软化”后,予罗盖全0.25 μg 2次·日-1,钙尔奇D 0.6 g/次/天口服,中性磷溶液口服,5例停用阿德福韦酯,1例因肝炎控制不佳继续服用阿德福韦酯,服用剂量减为10 mg·次-1,2日1次,治疗一年后骨痛症状消失,2年后生化检查及骨密度BMD均恢复正常,长距离行走自如。肝功能和乙肝病毒控制良好。同时对6例患者的中医证候分析,发现其主要都有肾精亏虚,并文献回顾。结论：乙肝经阿德福韦酯治疗患者的病情发展受中医“肝肾同源”理论影响,易出现肾功能损伤、低磷骨软化症,联合运用中医补肾活血中药对阿德福韦酯导致的低磷骨软化和肾功能损伤有防治作用。

Exploration on Pathogenesis and 6 Cases of Hypo-phosphate Osteomalacia

Objective: To explore the pathogenesis and prevention and cure of renal injury and osteomalacia caused byantiviral drugs in 6 cases of low phosphorus osteomalacia patients after taking adefovir Dipivoxil and analysis of TCMsyndrome on the basis of .homogeny of liver and kidney. Methods: In this case series, 6 unrelated blood relationshippatients with chronic hepatitis B were treated with adefovir with hypo- phosphorus osteomalacia were reported. Allpatients were analyzed by TCM symptoms. Considering the occurrence of hypo- phosphorus osteomalacia and renalinjury, viral hepatitis was analyzed after treatment, and literature review was carried out, and the pathogenesis of renaltubule injury caused by Adefovir was summarized. Combined with the combination analysis of TCM syndrome of the disease, according to the theory of "liver and kidney homology" of traditional Chinese medicine and the characteristics of the pathogenesis of "kidney control bone", the TCM pathogenesis is analyzed. Results: All 6 patients were treated with adefovir dipivoxil 10mg·d for 48-84 months. In each case, the bone density decreased, the blood phosphorus decreased,the alkaline phosphatase increased and the fracture image of different degrees, and the tongue and TCM syndrome typeswere classified as "liver and kidney deficiency" type, accompanied by "qi stagnation and blood stasis". After thediagnosis of "low phosphorus osteomalacia", 2 times per day, 2 times per day, 1 times per day, 1 times per day, 5 cases ofadefovir Dipivoxil and 1 cases of adefovir dipivoxil for poor control of hepatitis and 1 times of 2 day for 2 days, thetreatment of bone pain symptoms disappeared after one year and 2 years later. BMD and bone mineral density returned tonormal. Liver function and HBV are well controlled. At the same time, 6 cases of TCM syndrome analysis, found thatmost of them have kidney essence deficiency, and literature review. Conclusion: The development of patients with hepatitis B treated with adefoviri influenced by the theory of "liver and kidney homology" in Chinese medicine. It is easy to have renal function injury and hypo- phosphorus osteomalacia, and the use of traditional Chinese medicine forinvigorating kidney and promoting blood circulation can prevent and cure the low phosphorus osteomalacia and renalfunction injury caused by adefovir.