【摘要】 目的探讨阿德福韦酯(ADV)致低磷骨软化症与恶性肿瘤骨转移的鉴别诊断方法,提高诊断ADV致低磷骨软化症的准确率。方法对10例ADV致低磷骨软化症患者及36例恶性肿瘤骨转移患者的骨显像结果及血清碱性磷酸酶(ALP)水平进行回顾性分析,总结分析两种疾病的影像学表现特点及血清ALP水平差异情况。结果 1)影像学表现差异:ADV致低磷骨软化症患者的骨显像总体表现出代谢性骨病的影像学特点,病变主要累及颅骨、长骨干骺端(关节)、肋骨等,部分患者可出现串珠肋表现,去除病因后病变呈现可逆性的特点;骨转移患者病变分布无规律、范围大小不一,极少累及负重关节,随着病情的进展病变数量会增加;2)血清ALP差异:ADV致低磷骨软化症患者血清ALP水平升高者比例高于恶性肿瘤骨转移患者,差异有统计学意义(2=12.54,P<0.001);ADV致低磷骨软化症患者血清ALP水平高于恶性肿瘤骨转移患者,差异有统计学意义(U=74.00,P=0.005)。结论根据影像学表现的差异结合病史、临床表现、骨密度及血清ALP水平对ADV致低磷骨软化症和恶性肿瘤骨转移进行鉴别诊断更为全面。更多还原

【Abstract】 Objective To investigate the method for differential diagnosis of adefovir dipivoxil induced hypophosphatemic osteomalacia and tumor with bone metastasis,so as to improve the diagnostic accuracy of adefovir dipivoxil induced hypophosphatemic osteomalacia. Methods A retrospective analysis was made upon the result of bone imaging and level of serum alkaline phosphatase( ALP),from 10 patients with adefovir dipivoxil induced hypophosphatemic osteomalacia and 36 patients with bone metastasis. Also,we summarized and analyzed the characteristics of bone imaging and the differences level of serum ALP. Results 1)Differences of imaging findings: Bone imaging of patients with adefovir dipivoxil induced hypophosphatemic osteomalacia overall presented the characteristics of metabolic bone disease,lesions mainly involved skull,long bone metaphysis( joint),rib,and so on. Some patients can present rachitic rosary performance,and the lesions presented the characteristic of reversibility after causes of disease removed. For bone imaging of patients with bone metastasis,lesions distributed irregularly,the range of lesions and size were also different,but lesions rarely involved weight-bearing joints,the number of lesions always increased with the progression of disease; 2) Differences of serum ALP: The rate of serum ALP level rise of patients with adefovir dipivoxil induced hypophosphatemic osteomalacia was higher then patients with bone metastasis,the difference was statistically significant( 2= 12. 54,P <0. 001). The serum ALP level of patients with adefovir dipivoxil induced hypophosphatemic osteomalacia was higher then patients with bone metastasis,the difference was statistically significant( U = 74. 00,P = 0. 005). Conclusion More comprehensively differential diagnosis of adefovir dipivoxil induced hypophosphatemic osteomalacia and tumor with bone metastasis can be carried out by the differences of imaging findings combined with medical history,clinical performance,bone mineral density and level of serum ALP.更多还原