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目的:探讨阿德福韦酯致范可尼综合征的临床特征、机制以及分布特点。方法:对1例应用阿德福韦酯治疗慢性乙型肝炎后发生低血磷性骨软化症的病例进行分析,并在全球范围内就其发生情况进行文献复习。结果:1例患者的临床症状出现时间是连续服用阿德福韦酯10 mg qd 5年之后,在停用阿德福韦酯24 d后,临床症状减轻,血磷恢复正常(症状较重时0.53 mmol·L-1,停用阿德福韦酯24 d时升至0.81 mmol·L-1),诊断为阿德福韦酯相关范可尼综合征、低血磷性骨软化症。复习文献发现阿德福韦酯导致的范可尼综合征均有血磷下降,尿酸水平下降,碱性磷酸酶上升,伴或不伴血钙下降及肌酐清除率下降。结论:服用阿德福韦酯治疗乙型肝炎的患者建议定期监测血磷、肌酐水平,如果出现低血磷提示发生肾小管损害,考虑更换抗病毒药物;长期服用阿德福韦酯的患者出现骨痛症状,考虑发生低血磷性骨软化症的可能性。
Objective: To investigate the clinical characteristics, mechanism and distribution of adefovir dipivoxil-induced nociceptive syndrome. Methods: One case of hypophosphatemia with adefovir dipivoxil after treatment of chronic hepatitis B was analyzed and literature review was conducted on its occurrence worldwide. Results: The onset of clinical symptoms in one patient was 5 years after taking adefovir dipivoxil 10 mg qd continuously. After 24 hours of withdrawal of adefovir dipivoxil, the clinical symptoms were relieved and the serum phosphorus returned to normal 0.53 mmol·L-1, adefovir dipivoxil to 0.81 mmol·L-1 on 24 d), diagnosis of adefovir dipivoxil-related Fanconi syndrome, hypophosphatemia osteomalacia. Review of the literature found adefovir dipivoxil-induced vancomycin syndrome have decreased serum phosphorus, uric acid levels decreased, alkaline phosphatase increased with or without decreased serum calcium and creatinine clearance decreased. CONCLUSIONS: Adefovir dipivoxil treatment for hepatitis B patients recommends regular monitoring of serum phosphate and creatinine levels, renal tubular damage if hypophosphatemia is present, or replacement of antiviral drugs; long-term use of adefovir dipivoxil appears in patients Bone pain symptoms, consider the possibility of hypophosphatemia osteomalacia.