药物不良反应杂志
藥物不良反應雜誌
약물불량반응잡지
ADVERSE DRUG REACTIONS JOURNAL
2014年
1期
52-53
,共2页
阿德福韦酯%范科尼综合征%脊髓病%周围神经系统疾病
阿德福韋酯%範科尼綜閤徵%脊髓病%週圍神經繫統疾病
아덕복위지%범과니종합정%척수병%주위신경계통질병
Adefovir dipivoxil%Fanconi syndrome%Spinal cord diseases%Peripheral nervous system diseases
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B1、B12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.
1例63歲男性乙型肝炎肝硬化患者服用阿德福韋酯10 mg,1次/d.用藥約3年半後齣現雙下肢痳木、無力,4年後齣現步態不穩.實驗室檢查示血燐0.37 mmol/L;肌電圖檢查示雙下肢深感覺徑路傳導阻滯,攷慮脊髓病閤併週圍神經病.給予維生素B1、B12治療後好轉.約2箇月後,患者再次齣現雙下肢痳木、無力.尿液檢查:α1微毬蛋白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.骨密度檢查提示骨量減少.攷慮阿德福韋酯相關範科尼綜閤徵.停用阿德福韋酯,改為口服恩替卡韋0.5 mg,1次/d,同時給予多維元素片、骨化三醇.18 d後複查,血燐0.75 mmol/L,下肢無力減輕.停用阿德福韋酯5箇月後,患者可正常行走.實驗室複查:尿α1微毬蛋白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,血燐0.90 mmol/L.
1례63세남성을형간염간경화환자복용아덕복위지10 mg,1차/d.용약약3년반후출현쌍하지마목、무력,4년후출현보태불은.실험실검사시혈린0.37 mmol/L;기전도검사시쌍하지심감각경로전도조체,고필척수병합병주위신경병.급여유생소B1、B12치료후호전.약2개월후,환자재차출현쌍하지마목、무력.뇨액검사:α1미구단백257.8 mg/L,미량백단백168 mg/L,N-을선-β-D-안기포도당감매90 U/L.골밀도검사제시골량감소.고필아덕복위지상관범과니종합정.정용아덕복위지,개위구복은체잡위0.5 mg,1차/d,동시급여다유원소편、골화삼순.18 d후복사,혈린0.75 mmol/L,하지무력감경.정용아덕복위지5개월후,환자가정상행주.실험실복사:뇨α1미구단백32.8 mg/L,뇨미량백단백14 mg/L,뇨N-을선-β-D-안기포도당감매15 U/L,혈린0.90 mmol/L.
A 63-year-old man with hepatitis B and cirrhosis received oral adefovir dipivoxil 10 mg once daily.About three and a half years after the start of the drug therapy,the patient developed numbness and weakness of lower limbs.He experienced unstable walking in the forth years.Laboratory tests revealed a serum phosphate level of 0.37 mmol/L.Electromyogram showed deep sensory pathway conduction block of bilateral lower limbs.The spinal cord diseases complicated with peripheral neuropathy was considered.After treatment with vitamin B1 and B12,the patient improved.About two months later,the symptoms of lower limb numbness and weakness relapsed.Urinalysis showed alpha 1-microglobulin 257.8 mg/L,microalbumin 168 mg/L and N-acetyl beta-D-glucosaminidase 90 U/L.Bone mineral density examination revealed osteopenia.The patient was diagnosed with Fanconi syndrome related to adefovir dipivoxil.Adefovir dipivoxil was stopped and his therapy was switched to oral entecavir 0.5 mg once daily.At the same time,he was given multivitamin and minerals tablets and calcitriol.Eighteen days later,the serum phosphate level rose to 0.75 mmo[/L and the degrees of lower limb weakness relieved.Five months later,he walked normally.Repeat laboratory tests showed the following levels:urine alpha 1-microglobulin 32.8 mg/L,microalbumin 14 mg/L,N-acetyl beta-D-glucosaminidase 15 U/L,and serum phosphate 0.90 mmol/L.
