摘要
1例63岁女性患者因慢性乙型肝炎长期口服阿德福韦酯（10 mg,1次/d）.用药第7年患者出现右膝和左肩部疼痛,随后相继出现右侧髋部以及双侧肋骨、髋部、膝盖和足跟疼痛.用药第8年疼痛进展到下背部,右侧髋部痉挛性疼痛,行走无力,活动受限.实验室检查：血磷0.48 mmol/L,钙2.28 mmol/L,尿酸77μmol/L;尿糖（＋）,尿蛋白（＋＋）,尿隐血（＋）,尿 β2微球蛋白2.5 mg/L.骨密度测定提示骨量减少.骨盆X线检查示髋骨骨质疏松,右侧股骨颈骨折.诊断：阿德福韦酯致范科尼综合征合并股骨颈病理性骨折.停用阿德福韦酯,改用恩替卡韦0.5 mg口服、1次/d,并给予果糖二磷酸钠（10 g、1次/d）、5％碳酸氢钠注射液（125 ml、1次/d）静脉滴注,碳酸钙（1500 mg/d、1次/d）、阿法骨化醇胶囊（0.25μg、3次/d）口服.1周后行右侧股骨头置换术联合右侧股骨干钢板内固定术,术后继续上述治疗.停用阿德福韦酯后5周复查,血磷0.72 mmol/L,尿酸136μmol/L,尿蛋白（＋）,骨痛明显好转;停用阿德福韦酯后5个月复查,血磷0.87 mmol/L,尿酸215μmol/L,尿糖（-）,尿蛋白（-）;停用阿德福韦酯后9个月复查,血磷1.02 mmol/L,可以正常行走.
A 63-year-old female patient received oral adefovir dipivoxil 10 mg once daily for chronic hepatitis B. She developed right knee and left shoulder pain at the 7th year of the treatment,followed by right hip pain and bilateral pain in the ribs,hips,knees and heels. Osteodynia progressed to the lower back and weakness and limited mobility in the 8th year. Laboratory tests showed the following values：serum phosphorus 0. 48 mmol/ L,calcium 2. 28 mmol/ L,uric acid 77 μmol/ L,urine glucose （＋）,urinary protein （＋＋）,urinary occult blood test （＋）,urinary β2-microglobulin 2. 5 mg/ L. Bone mineral density examination revealed osteopenia. Pelvic X-ray examination showed the osteoporosis of the hip and right femoral neck fracture. The patient was diagnosed as adefovir dipivoxil-induced Fanconi syndrome and pathological femoral neck fracture. Adefovir dipivoxil was stopped and her therapy was changed to entecavir 0. 5 mg once daily. She was given IV infusion of fructose diphosphate 10 g once daily and 5% sodium bicarbonate injection 125 ml once daily,oral calcium carbonate 1500 mg once daily and alfacalcidol soft capsules 0. 25 μg thrice daily. One week later,the right femoral head replacement combined with the right femoral shaft fracture plate fixation was performed. The above-mentioned drugs were continued. After 5 weeks of adefovir dipivoxil discontinuation,serum phosphorus was 0. 72 mmol/ L,uric acid was 136 μmol/ L, urinary protein （＋）and the osteodynia was significantly alleviated. After 5 months of adefovir dipivoxil withdrawal,laboratory tests showed the following values：serum phosphate 0. 87 mmol/ L,uric acid 215μmol/ L,urine glucose （-）,urinary protein （-）. Four months later,the serum phosphate was 1. 02 mmol/ L,the patient could walk normally.
出处
《药物不良反应杂志》
CSCD
2017年第6期461-463,共3页
Adverse Drug Reactions Journal
关键词
阿德福韦酯
范科尼综合征
股骨颈骨折
Adefovir dipivoxil
Fanconi syndrome
Femoral neck fractures
