拉米夫定，恩替卡韦或替诺福韦治疗乙型肝炎感染：对钙，

StephenW

Ann Hepatol. 2017 Feb 15;16(2):207-214. doi: 10.5604/16652681.1231577.
Lamivudine, Entecavir, or Tenofovir Treatment of Hepatitis B Infection: Effects on Calcium, Phosphate, FGF23 and Indicators of Bone Metabolism.Saeedi R1, Mojebi-Mogharar A2, Sandhu S3, Dubland J3, Ford JA2, Yousefi M4, Pudek M1, Holmes D1, Erb S2, Peter Kwan W2, Kendler D3, Yoshida E2.
Author information

• 1Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
• 2Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
• 3Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada.
• 4Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
  

AbstractBACKGROUND: Patients with chronic hepatitis B virus (HBV) are often treated with nucleoside/nucleotide antiviral agents and metabolic bone toxicity is a possible concern.
OBJECTIVE: To determine the relationships between fibroblast growth factor 23 (FGF23), a phosphaturic hormone, bone mineral density (BMD), and bone biochemical abnormalities in these patients.
MATERIAL AND METHODS: This is a cross-sectional observational study comparing HBV-infected subjects treated for at least one year with tenofovir (TDF), lamuvidine (LVD), entacavir (ETV), or not treated (CON). Patients with abnormalities in either calcium (Ca), phosphate (PO4), intact parathyroid hormone (iPTH) or FGF23 were further evaluated with BMD by DXA.
RESULTS: No difference in liver enzymes or renal function seen among groups, but hypophosphatemia was seen in all groups with the highest incidence with TDF-treatment (14%). FGF 23 levels were found to be elevated in 11.1% of TDF patients, 2.77% amongst controls. No elevations were found in the LVD or ETV groups. Among a subset of subjects (FGF23, PO4, and/or Ca abnormalities) who underwent further evaluation, 67% had insufficient 25-OH vitamin D, and 30% had elevated 24 h urinary Ca or PO4 excretion. No patients with FGF23 abnormalities had urine abnormalities. 40% had low DXA Z-score (<-2) at spine or hip but there was no difference between control and antiviral treatment groups and the mean FRAX score was 2.33% for major osteoporotic fractures and 0.29% for hip fracture.
CONCLUSION: Abnormalities in bone metabolism, particularly involving vitamin D insufficiency, in HBV-treated subjects were observed with a small increased likelihood in TDF treated patients.


KEYWORDS: BMD; HBV; Vitamin D; fibroblast growth factor 23; hypophosphataemia

StephenW

Ann Hepatol。 2017 Feb 15; 16（2）：207-214。 doi：10.5604 / 16652681.1231577。
拉米夫定，恩替卡韦或替诺福韦治疗乙型肝炎感染：对钙，磷酸盐，FGF23和骨代谢指标的影响。
Saeedi R1，Mojebi-Mogharar A2，Sandhu S3，Dubland J3，Ford JA2，Yousefi M4，Pudek M1，Holmes D1，Erb S2，Peter Kwan W2，Kendler D3，Yoshida E2。
作者信息

    1病理学＆amp;实验医学，不列颠哥伦比亚大学，温哥华，不列颠哥伦比亚省，加拿大。
    2加拿大不列颠哥伦比亚大学胃肠病学系医学科。
    3，加拿大不列颠哥伦比亚大学内分泌学系，温哥华。
    加拿大不列颠哥伦比亚大学医学系，温哥华。

抽象
背景：

慢性乙型肝炎病毒（HBV）的患者通常用核苷/核苷酸抗病毒剂治疗，并且代谢骨毒性是可能的关注。
目的：

确定这些患者中成纤维细胞生长因子23（FGF23），磷酸激素，骨矿物质密度（BMD）和骨生化异常之间的关系。
材料与方法：

这是一项横断面观察性研究，比较用替诺福韦（TDF），拉米维林（LVD），恩替卡韦（ETV）或未治疗（CON）治疗至少一年的HBV感染患者。通过DXA进一步评价患有钙（Ca），磷酸盐（PO4），完整甲状旁腺激素（iPTH）或FGF23异常的患者的BMD。
结果：

在各组中观察到的肝酶或肾功能没有差异，但在所有组中均观察到低磷酸血症，TDF治疗的发生率最高（14％）。发现在11.1％的TDF患者中FGF23水平升高，在对照中为2.77％。在LVD或ETV组中未发现隆起。在进行进一步评价的受试者亚组（FGF23，PO4和/或Ca异常）中，67％具有不足的25-OH维生素D，30％具有升高的24小时尿Ca或PO4排泄。没有FGF23异常的患者有尿异常。 40％在脊柱或髋部具有低DXA Z评分（＆amp; amp; amp; <-2），但是在对照组和抗病毒治疗组之间没有差异，并且主要骨质疏松性骨折的平均FRAX评分为2.33％，并且0.29％为髋骨骨折。
结论：

观察到在HBV治疗的受试者中骨代谢，特别是涉及维生素D不足的异常，在TDF治疗的患者中具有小的增加的可能性。
关键词：

BMD; HBV;维生素D;成纤维细胞生长因子23;低磷血症