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1例63岁男性乙型肝炎肝硬化患者服用阿德福韦酯10 mg,1次/d。用药约3年半后出现双下肢麻木、无力,4年后出现步态不稳。实验室检查示血磷0.37 mmol/L;肌电图检查示双下肢深感觉径路传导阻滞,考虑脊髓病合并周围神经病。给予维生素B_1、B_(12)治疗后好转。约2个月后,患者再次出现双下肢麻木、无力。尿液检查:α1微球蛋白257.8 mg/L,微量白蛋白168 mg/L,N-乙酰-β-D-氨基葡萄糖苷酶90 U/L。骨密度检查提示骨量减少。考虑阿德福韦酯相关范科尼综合征。停用阿德福韦酯,改为口服恩替卡韦0.5 mg,1次/d,同时给予多维元素片、骨化三醇。18 d后复查,血磷0.75 mmol/L,下肢无力减轻。停用阿德福韦酯5个月后,患者可正常行走。实验室复查:尿α1微球蛋白32.8 mg/L,尿微量白蛋白14 mg/L,尿N-乙酰-β-D-氨基葡萄糖苷酶15 U/L,血磷0.90 mmol/L。
One 63-year-old man with hepatitis B cirrhosis received adefovir dipivoxil 10 mg once daily. About three and a half years after treatment, both lower extremities numbness, weakness, gait instability after 4 years. Laboratory tests showed phosphorus 0.37 mmol / L; EMG examination showed deep leg sensory pathway block, consider myelopathy with peripheral neuropathy. Given vitamin B_1, B_ (12) improved after treatment. About 2 months later, patients again appear numbness of both lower extremities, weakness. Urinalysis: α1 microglobulin 257.8 mg / L, microalbumin 168 mg / L, N-acetyl-β-D-glucosaminidase 90 U / L. Bone mineral density examination showed decreased bone mass. Consider adefovir dipivoxil-related Fanconi syndrome. Adefovir dipivoxil was stopped, entecavir 0.5 mg, 1 / d, while giving multi-dimensional elemental tablets, calcitriol. 18 d after the review, phosphorus 0.75 mmol / L, lower extremity weakness. Five months after the abortion of adefovir diphthete, the patient can walk normally. Laboratory review: urine α1 microglobulin 32.8 mg / L, urinary albumin 14 mg / L, urinary N-acetyl-β-D-glucosaminidase 15 U / L, phosphorus 0.90 mmol / L.