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1例57岁男性慢性乙型肝炎患者口服阿德福韦10 mg/d治疗,用药约3年发现晨起双足肿胀、疼痛,实验室检查示血清碱性磷酸酶水平升高;用药4年后因双下肢疼痛加重、乏力入首都医科大学宣武医院。体格检查示双下肢肌力4级,腱反射减弱,四肢痛觉减退;实验室检查显示血磷明显下降(0.59 mmol/L);肌电图检查提示神经源性损害;X线和超声检查示骨质疏松。诊断为阿德福韦相关性低血磷骨病和周围神经病,停用阿德福韦,改用恩替卡韦治疗。患者症状逐渐好转。1个月后血磷水平恢复正常(0.99 mmol/L),3个月后双下肢疼痛完全消失,肌力正常,骨质疏松明显好转。
A 57-year-old man with chronic hepatitis B was treated with oral adefovir 10 mg / d for about 3 years. Early swelling and pain were found in his feet. Laboratory tests showed elevated levels of serum alkaline phosphatase. After 4 years of treatment Due to increased pain in both lower extremities, fatigue into the Xuanwu Hospital Capital Medical University. Physical examination showed lower extremity muscle strength of 4, weakened tendon reflexes, decreased pain in limbs; laboratory tests showed a significant decrease in serum phosphorus (0.59 mmol / L); electromyographic examination revealed neurogenic damage; X-ray and ultrasonography Loose quality. Diagnosis of adefovir-related hypophosphatemia and peripheral neuropathy, disable adefovir, switch to entecavir treatment. Patient symptoms gradually improved. After 1 month, the blood phosphorus level returned to normal (0.99 mmol / L). After 3 months, the pain of both lower extremities completely disappeared, and the muscle strength was normal. Osteoporosis was obviously improved.