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目的探讨阿德福韦酯(10 mg/d)长期治疗慢性乙肝患者引起肾小管损害继发低磷软骨症的临床特点、治疗方法及预后。方法回顾性分析2011年11月至2013年11月我院内分泌科收治的5例阿德福韦酯致肾小管损害继发低磷软骨症患者的临床表现、实验室检查、影像学检查、治疗方案以及随访情况,并通过检索Pub M ed、中国知网全文数据库,结合相关文献报道病例进行比较分析。结果我院5例患者的临床表现主要为骨痛进行性加重;实验室检查主要为低血磷、高尿磷、高碱性磷酸酶(ALP)、低血钙。治疗方法:5例患者停用阿德福韦酯,加用碳酸钙D3及骨化三醇,4例给予补充中性磷溶液,2~8个月血磷正常,骨痛缓解。结论低剂量阿德福韦酯会引起低磷软骨症,建议长期用药的患者定期监测尿酸、肾小球滤过率(e GFR)、ALP、血磷、尿常规等,服药期间一旦出现不明原因的骨痛也应及时就医,以便尽早确诊,尽早停药治疗并对症处理。
Objective To investigate the clinical characteristics, treatment and prognosis of adefovir dipivoxil (10 mg / d) for chronic hypophthalmitis caused by tubulointerstitial damage in chronic hepatitis B patients. Methods The clinical manifestations, laboratory tests, imaging examination and treatment of five cases of adefovir dipivoxil-induced tubulointerstitial hypophthalmitis were retrospectively analyzed from November 2011 to November 2013 in our hospital. Program and follow-up, and through the search PubMed, CNKI full-text database, combined with relevant cases reported in the literature for comparative analysis. Results The clinical manifestations of 5 patients in our hospital were mainly aggravated by bone pain. The main laboratory tests were hypophosphatemia, hyperphosphatemia, ALP and hypocalcemia. Treatment: 5 patients discontinued adefovir dipivoxil, plus calcium D3 and calcitriol, 4 patients were given neutral phosphate solution, 2 to 8 months of normal phosphorus, bone pain relief. Conclusions Low-dose adefovir dipivoxil can cause hypophosphatemia. Long-term use of uric acid, glomerular filtration rate (GFR), ALP, serum phosphorus and urinary routine monitoring should be monitored regularly. Of the bone pain should also seek medical treatment in time for early diagnosis, early withdrawal treatment and symptomatic treatment.