抗甲状腺药物致血清肌酸激酶升高/横纹肌溶解症的文献综述

Literature Review of Antithyroid Drugs-Induced Serum Creatine Kinase Elevation / Rhabdomyolysis

关键词:  抗甲状腺药物  血清肌酸激酶  横纹肌溶解症  不良反应  文献综述

Key words:  antithyroid  drugs, serum  creatine kinase, rhabdomyolysis, adverse  drug reaction, literature  review

摘要:

目的: 分析抗甲状腺药物(Antithyroid Drugs,ATDs)致血清肌酸激酶(creatine kinase,CK)升高伴肌痛、横纹肌溶解症的临床特点,为临床实践提供证据和参考。方法: 计算机检索CNKI、WANFANG、VIP、CBM、PubMed和Embase数据库,截止时间2024年4月,纳入ATDs致CK升高伴肌痛或横纹肌溶解症的中英文文献。结果: 共检索文献1751篇,最终纳入39篇共52例ADR,血清CK升高50例,49例主诉肌痛；7例进展为横纹肌溶解症,其中1例并发急性肾损伤。涉及52名患者,多为亚洲人群(占80.8%),女性占73.1%,中位年龄为26.0岁(20.0,33.8),18岁以下儿童占17.3%。发生时间为ATDs治疗后7~122天,中位时间为30天(26.3,56.3)；处置措施包括ATDs减量、停药、换药,加用左甲状腺素等；肌痛症状消失时间为1~122天,中位时间为12天(2.5,21.0)；血清CK水平恢复正常的中位时间为24.5天(14.0,43.8)。10例患者在后续治疗中再次出现血清CK升高伴肌痛。结论: ATDs相关的血清CK升高伴肌痛是一种新的、罕见ADR,需要临床医护人员加强认识,减少误诊、漏诊,避免进展为横纹肌溶解症、急性肾损伤等。其存在剂量依赖性,且亚洲人群可能更易感,在ATDs初始治疗或增加剂量后2个月内,建议每月随访血清CK水平,尤其是主诉肌肉痉挛、肌痛的患者。

Abstract:

ABSTRACT: OBJECTIVE To analyse the clinical characteristics of serum creatine kinase (CK) elevation with myalgia and rhabdomyolysis induced by antithyroid drugs (ATDs), and to provide evidence and reference for clinical practice. METHODS A computerised search of CNKI, WANFANG, VIP, CBM, PubMed and Embase databases was conducted with a cut-off date of April 2024 to include Chinese and English literature on CK elevation with myalgia or rhabdomyolysis induced by ATDs. RESULTS A total of 1,751 literature articles were searched, and 39 articles with a total of 52 ADRs were finally included, with 50 cases of elevated serum CK and 49 cases complaining of myalgia; 7 cases progressed to rhabdomyolysis, including 1 case with concomitant acute kidney injury. Fifty-two patients were involved, mostly from Asian populations (80.8%), 73.1% female, with a median age of 26.0 years (20.0, 33.8) and 17.3% children under 18 years of age. The time of onset ranged from 7 to 122 days after treatment with ATDs, with a median of 30 days (26.3, 56.3); dispositions included ATDs dose reduction, discontinuation, substitution with other ATDs, or addition of levothyroxine; myalgia symptoms resolved within 1 to 122 days, with a median of 12 days (2.5, 21.0); and the median time to return to normal serum CK levels was 24.5 days (14.0, 43.8). 10 patients had a recurrence of elevated serum CK with myalgia during subsequent treatment. CONCLUSIONS ATDs-induced elevated serum CK with myalgia is a new and rare ADR that needs to be recognised by clinical staff to reduce misdiagnosis and underdiagnosis and to avoid progression to rhabdomyolysis, acute kidney injury, etc.. It is dose-dependent and may be more susceptible in Asian populations. Monthly monitoring of serum CK levels is recommended within 2 months of initial treatment or dose increase of ATDs, especially in patients complaining of muscle cramps and myalgia.