非诺贝特引起横纹肌溶解症

Rhabdomyolysis resulting from fenofibrate

1名48岁女性慢性肾功能不全透析患者,因血脂增高给予非诺贝特200mg口服,1次/晚。服药前查Hb97g/L,PLT202×109/L,血Cr907μmol/L,BUN30.62mmol/L,TG2.56mmol/L,TC5.4mmol/L,ALT16U/L,AST37U/L,CK52U/L,LDH182U/L,血电解质正常。服药11d后,患者出现乏力、周身肌肉酸痛,尿色加深,尿量自1800ml/d减少至250ml/d。查:Hb79g/L,PLT102×109/L,Cr1112μmol/L,BUN37.1mmol/L,K+8.7mmol/L,CK1979U/L,ALT619U/L,AST1880U/L,LDH3470U/L。尿常规:蛋白(+)、潜血(┼┼┼)。血气分析:pH7.503,PCO236.1mmHg,PO255mmHg,SO20.863。确诊为横纹肌溶解症,合并肝、肾功能损害。立即停用非诺贝特,予血液透析滤过治疗。6d后肌肉疼痛、乏力好转,尿量恢复至650ml;8d后Hb、PLT、血CK恢复正常;12d后肝功能恢复正常。

A 48-year-old women with chromic renal failure underwent dialysis therapy. She was given oral fenofibrate 200 mg every night for treating elevated blood lipid. Before administration, laboratory test showed the following vaules ： Hb 97 g/L, PLT 202 × 10^9/L, Cr 907 μmol/L, BUN 30.62 mmol/L, TG 2.56 mmol/L, TC 5.4 mmol/L, ALT 16 U/L, AST 37 U/L, CK 52 U/L, and LDH 182 U/L, and serum electrolyte concentrations were normal. After 11 days of treatment, she developed hypodynamia, general muscular soreness, dark urine, and the urine volume decreased from 1 800 ml/day to 250 ml/day. The laboratory examinations revealed the levels as follows： Hb 79 g/L, PLT 102 × 10^9/L, Cr 1 112 μmol/L, BUN 37.1 mmol/L, K＋ 8.7 mmol/L, CK 1 979 U/ L, AEr 619 U/L, AST 1 880 U/L, LDH 3 470 U/L. The urine routine test showed protein （ ＋ ） and RBC （＋＋＋）. Arterial blood gas analysis revealed a pH level of 7. 503, a partial carbon dioxide pressure level of 36.1 mmHg, a partial oxygen pressure level of 55 mmHg, and an oxygen saturation of level 0. 863. She was diagnosed as a case of rhabdomyolysis with liver and renal functional damage. Fenofibrate was stopped immediately. The patient was underwent hemodiafihration. Six days later, her myalgia and debilitation improved. Her urine volume returned to 650 ml/d. Eight days later, her Hb, PLT, and Cr normalized. Twelve days later, her liver function returned to normal limits.