| Objective:Through the analysis of 10 cases of clinical data of patients with hypophos phatemic osteomalacia(HO), combining with literature review, enhance the unde rstanding of the disease for clinicians. Hope to improve the diagnosis rate of the disease, as far as possible do early diagnosis and early treatment. Avoid unnece ssary missed diagnosis and misdiagnosis.Methods:Retrospective analysis of 10 cases of patients with hypophosphatemic osteo malacia related clinical history, physical examination, laboratory and imaging exa mination, diagnosis, and treatment measures, and carry on the literature review, t o study the pathogenesis, clinical characteristics, diagnosis method, treatment and prognosis of different types of HO.Results:1. Clinical manifestations: all 10 patients with clinical manifestations are diff erent degrees of bone pain, pain is often occurred in load-bearing part such as j oints, waist, chest, back and foot. As the illness progress, the pain gradually by the local bone pain progress for the whole body bone pain, some patients appear shorter height, severe cases occurred after thoracic vertebra protrusion deformity merge the activity obstacle of lower limbs. Physical examination can find differ ent degree of bone and joint tenderness.2. Auxiliary examination: this group of 10 cases with blood in low Phospho rus, Urinary Phosphorus inappropriately discharge in the case of low blood Phos phorus, basic normal blood Calcium, Alkaline Phosphatase was higher in most of cases, Vitamin D was reduced in some patients, Parathyroid Hormone most norm al or slightly elevated. Bone X ray shows typical osteomalacia performance, and skeletal deformities, vertebral compression and spurious fractures could be foundin serious cases. Whole body bone ECT and systemic PET-CT could show the performance of metabolic bone diseases such as multiple focal bone density dec reases and multiple radioactive anomaly concentrated expression. A patient with l ong-term oral adefovir dipivoxil(ADV) which renal biopsy pathological show obv ious injury of renal tubular epithelial cells, disappear of brush border, and part o f the epithelial cell necrosis falls off within the lumen, focal necrosis is visible.3. The diagnosis: 4 cases in this group of long-term oral ADV antiviral trea tment for chronic hepatitis b patients, therefore, consider diagnostic hypophospha temic osteomalacia caused by ADV. The remaining 6 cases did not find out th e cause, consider due to unknown causes hypophosphatemic osteomalacia, sug gesting further examination such as genetic testing and whole body Octreotide sc an in order to define the diagnosis.4. treatment: 4 cases of chronic hepatitis b patients to stop ADV, changed t o other antiviral drugs. 10 cases are added neutral phosphorus, calcium and vita min D, such as conventional treatment, among them 6 cases review blood phosp horus are different degree increased after the treatment, 4 cases of hospital stay did not review the blood phosphorus. All patients with bone pain to some extent alleviated.Conclusion:Hypophosphatemic osteomalacia in clinic is relatively rare, less reported case s at home and abroad. Its pathogenesis is complex, lack of characteristic clinical ma nifestations, clinical doctors know less to it, which easily lead to misdiagnosis and mi ssed diagnosis. Through detailed history, careful physical examination and auxiliary ex aminations, can improve the diagnosis rate of the disease, as far as possible do earl y diagnosis and early treatment. In patients with diagnosis of the disease should be given different treatment according to the different causes, in order to get a better pr ognosis. |
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