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1例46岁男性慢性乙型肝炎患者10年前开始规律服用阿德福韦酯(10 mg,1次/d),近3年出现进行性加重的胸背部疼痛,近1年出现四肢乏力、行走困难。体格检查:颈椎、上胸椎水平椎体和肩胛骨、肋骨处压痛,肋弓外翻,直腿抬高试验阳性。实验室检查:血钾3.1 mmol/L,氯111 mmol/L,钙2.2 mmol/L,磷0.53 mmol/L,尿酸117μmol/L,空腹葡萄糖4.1 mmol/L,碱性磷酸酶(ALP)201 U/L,乙型肝炎表面抗原、e抗体、核心抗体均为阳性;尿葡萄糖(++),蛋白质(+),微量白蛋白70.9 mg/L,α1微球蛋白168.0 mg/L,蛋白定量0.93g/24 h。肾动态显像检查显示双肾肾小球滤过功能中度受损。血气分析示pH 7.24,二氧化碳分压31 mmHg(1 mmHg=0.133 kPa),碳酸氢根浓度13 mmol/L。全身骨扫描提示全身多发骨代谢活跃灶;X线胸片示两胸部多发性肋骨骨折;骨密度测定示重度骨质疏松。诊断为阿德福韦酯致范科尼综合征合并骨软化。停用阿德福韦酯,予补钙和补磷等治疗。6 d后复查,血磷升至0.71 mmol/L。出院后继续服用上述药物治疗。半年后复查,患者可大步行走,血磷0.81 mmol/L。
A 46-year-old man with chronic hepatitis B started adefovir dipivoxil (10 mg once / d) regularly 10 years ago. His thoracolumbar pain developed exacerbated in the past 3 years and his limbs became weak in the past year. Difficult to walk. Physical examination: cervical vertebra, thoracic vertebral horizontal and scapula, tenderness ribs, valgus bow valgus, straight leg raising test positive. Laboratory tests included 3.1 mmol / L potassium, 111 mmol / L chlorine, 2.2 mmol / L calcium, 0.53 mmol / L phosphorus, 117 μmol / L uric acid, 4.1 mmol / L fasting glucose and 201 U / L, positive for hepatitis B surface antigen, e antibody and core antibody; urinary glucose (++), protein (+), albumin 70.9 mg / L, α1 microglobulin 168.0 mg / g / 24 h. Renal dynamic imaging showed moderate renal glomerular filtration dysfunction. Blood gas analysis showed pH 7.24, partial pressure of carbon dioxide 31 mmHg (1 mmHg = 0.133 kPa) and bicarbonate concentration 13 mmol / L. Whole-body bone scan prompted active multi-bone metabolism; chest X-ray showed multiple chest fractures of the ribs; measured bone mineral density showed severe osteoporosis. Diagnosis of adefovir dipivoxil-induced nociception with osteomalacia. Disable adefovir dipivoxil, to calcium and phosphorus and other treatment. After 6 d review, serum phosphorus rose to 0.71 mmol / L. After discharge, continue to take the above drug treatment. Six months after the review, the patient can walk large, phosphorus 0.81 mmol / L.