Xu Li-Jun, Jiang Yan, Liao Ruo-Xi, Zhang Hua-Bing, Mao Jiang-Feng, Chi Yue, Li Mei, Wang Ou, Liu Xiao-Qing, Liu Zheng-Yin, Xing Xiao-Ping, Yu Wei, Xia Wei-Bo
Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Antivir Ther. 2015;20(6):603-11. doi: 10.3851/IMP2954. Epub 2015 Mar 27.
Adefovir dipivoxil (ADV) nephrotoxicity is well known at a dose of 60 mg day(-1) or 120 mg day(-1). However, renal toxicity at a low-dose of 10 mg ADV for HBV-infected patients is not fully described. Our objective was to analyse the clinical features and outcomes of ADV-related Fanconi's syndrome in the Chinese population.
This was a retrospective study. A total of 35 patients with ADV-related Fanconi's syndrome were studied. Clinical manifestations and biochemical parameters were analysed. 19 patients were from Peking Union Medical College Hospital (PUMCH) included from August 2010 to December 2012. A total of 16 patients were eligible from case reports in the Chinese population retrieved in PUBMED, WANFANG and CNKI database. Bone mineral density and biochemical parameters including serum phosphate, calcium, creatinine, alkaline phosphatase (ALP) were measured before and after ADV cessation and during the follow-up.
All recruited patients had hypophosphataemia, increased urinary phosphate excretion and elevated alkaline phosphatase. Serum phosphate levels rapidly increased especially within the 4 weeks after ADV cessation. Serum creatinine remained high or at the upper limit of normal range even after ADV cessation for 1 year. ALP increased in the first three months of ADV cessation and decreased at the 24th week. Bone mineral density was significantly improved after 6 months cessation of ADV.
ADV can be nephrotoxic at prolonged low doses of 10 mg. For those who take ADV long term, regular monitoring of serum phosphate, creatinine levels and urine routine tests are required.
阿德福韦酯（ADV）在剂量为60毫克/天或120毫克/天时的肾毒性是众所周知的。然而，对于乙肝感染患者，低剂量10毫克ADV的肾毒性尚未得到充分描述。我们的目的是分析中国人群中与ADV相关的范科尼综合征的临床特征和结局。
这是一项回顾性研究。共研究了35例与ADV相关的范科尼综合征患者。分析了临床表现和生化参数。19例患者来自北京协和医院（PUMCH），纳入时间为2010年8月至2012年12月。从PUBMED、万方和知网数据库中检索到的中国人群病例报告中，共有16例患者符合条件。在停止使用ADV前后以及随访期间，测量骨密度和生化参数，包括血清磷酸盐、钙、肌酐、碱性磷酸酶（ALP）。
所有纳入患者均有低磷血症、尿磷排泄增加和碱性磷酸酶升高。血清磷酸盐水平迅速升高，尤其是在停止使用ADV后的4周内。即使在停止使用ADV 1年后，血清肌酐仍保持在高水平或正常范围上限。ALP在停止使用ADV的前三个月升高，在第24周时下降。停止使用ADV 6个月后，骨密度明显改善。
长期低剂量10毫克的ADV可能具有肾毒性。对于长期服用ADV的患者，需要定期监测血清磷酸盐、肌酐水平和尿常规检查。
