摘要:大量的药物促进了钙焦磷酸盐沉积病(CPDD)的发生。我们报告2例静脉注射唑来膦酸治疗后发生急性CPDD的案例。病例1：一位63岁的女性在骨质疏松性骨折的部位接受椎体成形术。手术后第二天，她接受了5毫克唑来膦酸的静脉注射。然而24小时后她的右膝盖出现了急性CPDD。从关节液成分分析和标准X线摄影的结果证实了该诊断。病例2：一位79岁的妇有CPDD的病史是使用糖皮质激素和羟基氯喹治疗狼疮。她每年静脉输注唑来膦酸5毫克预防糖皮质激素引起的骨质疏松症。同日晚些时候发生关节疼痛和发烧。五天后，她右手腕出现了关节炎，实验室结果证实出现了系统性炎症和低钙血症。放射线也显示发生了CPDD的证据。Medline搜索发现了6例双磷酸盐相关的CPDD，其中2例帕米膦酸盐，2例依地膦酸盐，1例阿仑膦酸，1例亚硝膦酸。其特征与我们的病人相似，症状发作时间短，全身炎症多，有低钙血症的倾向，以及经常有CPDD证据的X线片。双磷酸盐相关的CPDD的确罕见，但风湿病学家还是应该重视。同时，患者在进行双磷酸盐治疗时，应考虑药物在症状中的作用。

附原文：Anumber ofmedicationspromote the development of calciumpyrophosphate deposition disease (CPDD). Wereport 2 cases of acute CPDD after intravenous zoledronic acid therapy. Case #1:a 63-year-old female was admitted for vertebroplasty at the site of anosteoporotic fracture. She received an intravenous infusion of zoledronic acid5 mg on the day after the procedure. Acute CPDD developed in her right knee 24hours later. Findings from joint aspiration and standard radiography confirmedthe diagnosis. Case #2:this 79-year-old woman had a history of CPDD was onglucocorticoid and hydroxychloroquine therapy for lupus. She was given anintravenous infusion of zoledronic acid 5 mg as prophylaxis of glucocorticoidinduced osteoporosis. Joint pain and a fever developed later on the sameday.After 5 days, she had arthritis of the right wrist, laboratory evidence ofsystemic inflammation, and hypocalcemia. Radiographs showed evidence of CPDD. AMedline search identified 6 cases of bisphosphonate-related CPDD, including 2due to pamidronate, 2 to etidronate, 1 to alendronic acid, and 1 to neridronicacid. The features were similar to those in our patients, with a shorttime toonset, systemic inflammation in many cases, a tendency toward hypocalcemia, andradiographs that often showed evidence of CPDD. Bisphosphonate-induced CPDD isa rare eventuality that should nevertheless be borne in mind byrheumatologists. Also, in patients with CPDD while taking bisphosphonatetherapy, a role for the drug in the symptoms should be considered.

引自：Couture G, Delzor F, Bagheri H, et al.First cases of calcium pyrophosphate deposition disease after zoledronic acidtherapy[J]. Joint Bone Spine, 2016, 84(2).