本文選題：阿德福韋酯 + 低磷血癥��； 參考：《浙江大學》2017年碩士論文

【摘要】：目的:探討阿德福韋酯致低磷骨軟化伴多發(fā)骨折的臨床特點和治療方法,有助于該疾病的早期診斷和正確治療,減少患者痛苦。方法:回顧性分析2015、2017年在浙江大學附屬第二醫(yī)院內分泌科住院治療的2例阿德福韋酯致低磷骨軟化患者的臨床病史、實驗室檢查、影像學資料、治療方法、治療效果,并復習相關文獻資料。結果:2例患者長期服用10mg/天阿德福韋酯抗病毒治療,均因骨痛伴活動障礙就診,血液檢查以低血磷、高堿性磷酸酶為突出表現,合并不同程度低尿酸血癥,尿液檢查發(fā)現尿磷、葡萄糖、蛋白、尿酸排泄增加,骨密度顯示骨量減低,結合病史及輔助檢查診斷為阿德福韋酯繼發(fā)的低磷骨軟化。更換抗病毒藥物,中性磷制劑補磷、補充活性維生素D及補鈣治療后疼痛逐漸緩解,血磷回復至正常水平。結論:長期小劑量阿德福韋酯抗病毒治療可導致Fanconi綜合征,進一步引起低磷骨軟化。長期服用阿德福韋酯的患者應定期檢測血磷,出現骨痛、乏力等癥狀應及時就診。
[Abstract]:Objective: to investigate the clinical characteristics and treatment of low phosphorus osteomalacia associated with multiple fractures caused by adefovir ester, which is helpful to the early diagnosis and correct treatment of the disease and reduce the pain of the patients. Methods: the clinical history, laboratory examination, imaging data, treatment methods and therapeutic effects of 2 patients with low phosphorus osteomalacia induced by adefovir were retrospectively analyzed in the Department of Endocrinology, second affiliated Hospital of Zhejiang University in 2015 and 2017. And review the relevant literature. Results two patients were treated with antiviral therapy of 10mg/ day adefovir ester for a long time, all of them were treated with bone pain and dyskinesia. The blood examination showed low blood phosphorus and high alkaline phosphatase, combined with different degree of hypouricemia. Urine examination found urine phosphorus. Glucose, protein, uric acid excretion increased, bone mineral density (BMD) decreased, combined with history and auxiliary examination of the diagnosis of adefovir dipivoxil secondary low phosphorus osteomalacia. After replacement of antiviral drugs, supplementation of phosphorus with neutral phosphorus, the pain was gradually alleviated after supplementation of active vitamin D and calcium, and blood phosphorus returned to normal level. Conclusion: long-term low-dose adefovir ester antiviral therapy can lead to Fanconi syndrome and further low-phosphorus osteomalacia. Patients who take adefovir should regularly detect blood phosphorus, bone pain, fatigue and other symptoms.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R68
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本文編號：1800706