目的 通过对5例阿德福韦酯引起肾小管损害继发低磷软骨症患者的临床特点、诊疗情况进行总结并结合文献资料,归纳出该类患者的药学监护要点。方法 检索近年来国内外有关阿德福韦酯引起低磷软骨病的相关文献,并结合临床中5例患者的诊疗情况,指导该类患者进行正确的补磷以及相关指标的正确监测。结果 阿德福韦酯致肾小管损害继发低磷软骨症的可能机制主要与基因缺陷相关,多见于小剂量(10 mg·d-1)服用1年以上,并随着时间延长,症状逐渐加重。通过停用阿德福韦酯或换用其他抗病毒药物,并予以补磷、补钙、补维生素D等对症治疗,可以达到良好的预后。结论 阿德福韦酯致肾小管损害继发低磷软骨症,临床特征缺乏特异性,极易引起误诊,因此临床上应予以重视。
Abstract
OBJECTIVE To summarize the outcomes and clinical features of hypophosphatemic osteomalacia secondary to renal tubular damage caused by adefovir and put forword the key points of pharmaceutical care for these patients. METHODS Literature was retrieved about hypophosphatemic osteomalacia secondary to renal tubular damage caused by adefovir in recent years. Combining the clinical situations of five patients with the named damage, they were treated with complement of phosphorus preparations and monitored for related clinical indicators. RESULTS The possible mechanisms of adefovir for causing hypophosphatemic osteomalacia secondary to renal tubular damage is gene defect. Hypophosphatemic osteomalacia often occurrs in patients taking small doses (10 mg穌-1) of adefovir for more than one year. The symptoms aggravate over time. By withdrawing adefovir or switching to other antiviral drugs and giving syptomatic treatment with phosphorus, calcium, and vitamin D supplements and other measures, good prognosis was achieved. CONCLUSION Hypophosphatemic osteomalacia secondary to renal tubular damage caused by adefovir is lack of specific clinical features, which is easy to be misdiagnosed, therefore attention should be paid by clinical professionals.
关键词
阿德福韦酯 /
肾小管损害 /
低磷软骨症 /
临床药师 /
药学监护
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Key words
adefovir dipivoxil /
tubular damage /
phosphorus osteomalacia /
clinical pharmacist /
pharmaceutical care
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中图分类号：
R969.3
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参考文献
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脚注
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基金
解放军总医院科技创新苗圃基金资助项目(13KMM46)
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