一名接受替诺福韦治疗的慢性乙型肝炎患者因肾毒性导致的骨闪烁显像及继发性骨软化症

Bone scintigraphy and secondary osteomalacia due to nephrotoxicity in a chronic hepatitis B patient treated with tenofovir.

作者信息

Gómez Martinez M V, Gallardo F G, Pirogova T, García-Samaniego J

机构信息

Servicio de Medicina Nuclear y Unidad de Hepatología, Hospital Carlos III, Centro de Investigación Biomédica en Red de Enfermedades y Digestivas (CIBERehd), Madrid, Spain.

出版信息

Rev Esp Med Nucl Imagen Mol. 2014 Mar-Apr;33(2):103-5. doi: 10.1016/j.remn.2013.05.011. Epub 2013 Aug 4.

DOI:10.1016/j.remn.2013.05.011

PMID:23920225

Abstract

Tenofovir is a nucleotide analogue used for the treatment of chronic hepatitis B and HIV infection. The safety of tenofovir is high but it has been described that tenofovir produces tubular toxicity and Fanconi's syndrome in some HIV-infected patients. To our knowledge this is the first documented case of bone involvement in Fanconi's syndrome in a patient treated with tenofovir for chronic hepatitis B without HIV coinfection. Bone scintigraphy has proven to be very useful for the diagnosis of secondary osteomalacia. Normalization of the bone scan after the withdrawal of the drug and the decline in alkaline phosphatase and phosphate serum levels reinforce the cause-effect relationship.

摘要

替诺福韦是一种核苷酸类似物，用于治疗慢性乙型肝炎和艾滋病毒感染。替诺福韦的安全性较高，但已有报道称，在一些感染艾滋病毒的患者中，替诺福韦会产生肾小管毒性和范科尼综合征。据我们所知，这是首例记录在案的在未合并感染艾滋病毒的情况下接受替诺福韦治疗慢性乙型肝炎的患者出现范科尼综合征伴骨骼受累的病例。骨闪烁显像已被证明对继发性骨软化症的诊断非常有用。停药后骨扫描恢复正常以及碱性磷酸酶和血清磷酸盐水平下降，进一步证实了因果关系。