Analysis The Clinical Characteristics Of Hypophosphatemic Osteomalacia Due To Adefovir Dipivoxil

Background and purpose: Background and purpose: HBV infection is a global public health problem.The incidence of HBV infection in China is high,and the number of CHB is numerous.ADV is a representative drug of nucleoside(acid)analogs and is widely used clinically for antiviral therapy of CHB.In recent years,ADV-induced kidney damage,renal osteodystrophy,and even severe osteoporosis,multiple fractures,etc.,have been more and more discovered and recognized.At present,the pathogenesis of HO caused by ADV has not been fully elucidated.Some researchers have considered the active uptake of drugs by anion transporters of renal tubular epithelial cells,leading to their accumulation in renal tubular epithelial cells.The aim of this study was to summarize the clinical manifestations of HO caused by ADV,and to provide reference and help for the early detection,diagnosis and treatment of HO caused by ADV.Methods: A retrospective analysis of the case report and case analysis of HO caused by ADV in the Chinese Academic Journals Network Publishing Library(CNKI)was conducted in 2005-2018,with a total of 47 patients.The included cases were summarized according to the patient’s gender,age,major clinical manifestations,laboratory tests,imaging examinations,diagnosis and treatment,and prognosis.According to the patient’s blood phosphorus level,10 patients(21.28%)in mild hypophosphatemia group,16 patients(34.04%)in moderate hypophosphatemic group and 21 patients(44.68%)in severe hypophosphatemia group,three groups of patients The clinical features were compared.Results: 1.In this study,the number of male patients was more than that of females,and the male to female ratio was 2.62:1.2.The age of illness is between 22 and 79 years old.3.When the diagnosis of HO caused by ADV is clear,the total ADV administration time is 65.00(48.00,91.00)months;the time of first occurrence of HO symptoms after ADV is 47.00(32.00,62.00)months;the first occurrence of HO symptoms to the diagnosis The time is 18.00(10.00,24.00)months.4.There was no significant difference in gender,first symptom onset,first symptom and confirmed time between the three groups(P>0.05).5.Compared with the mild hypophosphatemic group,the patients with moderate hypophosphatemia and severe hypophosphatemia were older and had longer medication duration(both P<0.001).6.There was no significant difference in serum potassium,blood chlorine and serum calcium between the three groups(P>0.05).Compared with the mild hypophosphatemia group,the moderate hypophosphatemia group and the severe hypophosphatemia group had lower blood uric acid and higher serum creatinine,and the difference was statistically significant(P=0.0038,P<0.001).7.In this study,alkaline phosphatase was elevated in patients with severe hypophosphatemia compared with mild hypophosphatemia,and the difference was statistically significant(P=0.0047).There was no significant difference in parathyroid hormone between the three groups(P>0.05).8.There was no significant difference in urine glucose positive and urine protein positive between the three groups(>0.05).Compared with the moderate hypophosphatemia group,the 24-hour urinary phosphorus was lower in the patients with severe hypophosphatemia,and the difference was statistically significant(P<0.005).9.Compared with the mild hypophosphatemia group,patients with moderate hypophosphatemia and severe hypophosphatemia were more likely to have osteopenia(both P < 0.001).10.There were no significant differences in whether the three groups were misdiagnosed,whether they were discontinued or changed.(P>0.05).Conclusion:(1)Long-term application of ADV may lead to HO.(2)The main clinical manifestations of HO caused by ADV are low back pain,lower extremity pain,chest rib pain,limb numbness and joint pain.(3)The main laboratory examinations of HO caused by ADV are a decrease in blood phosphorus,and uricacid,an increase in serum creatinine,alkaline phosphatase,and 24-hour urinary phosphorus.(4)The imaging features of HO caused by ADV are related to the severity of bone mineral density and the severity of hypophosphatemia.The lower the blood phosphorus,the more likely the bone mass is reduced.