阿托伐他汀致相关性肌病的回顾性分析

Retrospective Analysis of the Related Myopathy Induced by Atorvastatin

关键词:  阿托伐他汀  肌病  合理用药  回顾性

Key words:  atorvastatin  the related myopathy  rational drug use  retrospective

摘要:

目的 探讨阿托伐他汀致相关性肌病的特点、影响因素、临床转归情况，促进临床合理用药。方法 检索中国知网全文数据库和万方数据库，统计分析他汀相关性肌病的药物不良反应（adverse drug reaction，ADR），并统计患者的年龄、性别、服用日剂量、发生ADR时服药时间、合并用药、基础疾病以及ADR临床表现、肌酸激酶（creatine kinase，CK）的变化、转归情况。结果 检索到38篇阿托伐他汀导致肌病发生的相关病例报告，共计41例。男性的发生率（60.98%）明显高于女性；>70岁老人（68.29%）是肌病发生的高危人群；初次服药或既往服用阿托伐他汀正常患者在服用阿托伐他汀过程中新增合并用药的前2个月内是肌病发生的危险期；肌病始发症状多见乏力、肌痛，偶见血尿/褐色尿/棕红色尿，恶心/食欲不振、抽搐、皮肤黄染，少见发热、心慌、局部肿胀。结论 阿托伐他汀致相关性肌病发生严重时可导致致死性事件；加强用药教育，避免自行添加药物，注意肌病发生的症状，用药后1~2个月密切监护肝肾功能及CK的变化，一旦出现肌病症状或CK升高，及时就医，避免致死性事件的发生。

Abstract:

OBJECTIVE To investigate the characteristics, related factors and clinical outcomes of atorvastatin-related myopathy so as to provide a basis of clinical rational drug use. METHODS The age, sex, daily dose, medication time of adverse drug reaction, combined medication, underlying disease, clinical manifestations, alteration of creatine kinase(CK), clinical manifestations as well as prognosis were analyzed by searching CNKI and Wanfang databases. RESULTS A total of 38 case reports included 41 case patients of atorvastatin-related myopathy were reported. The incidence of men(60.98%) was significantly higher than that of women. People older than 70 years(68.29%) were at high risk of developing myopathy. The first two months of initial medication or combined with other drugs was the high-risk period of myopathy. The initial symptoms of myopathy focus on fatigue, myalgia; hematuria/brown urine/brown red urine, nausea/appetite were occasional; convulsions, yellow skin stains, rare fever, palpitation, local swelling were rare. CONCLUSION The occurrence of atorvastatin associated myopathy in severe cases can lead to fatal events. Strengthen the use of education to avoid the self-addition of drugs, and pay attention to the symptoms of myopathy. Closely monitor the changes of liver and kidney function and CK within 1 to 2 months after the use of drugs. Once suspected related myopathy symptoms or elevation of CK, the patients should be given timely medical treatment to avoid the occurrence of fatal events.