辛伐他汀和阿托伐他汀与CYP3A4酶抑制剂/诱导剂在心内科患者中联用情况调查

Investigation of the co-administration of simvastatin or atorvastatin with cytochrome P4503A4 inhibitors or inducers in cardiology ward

目的:调查临床治疗中辛伐他汀和阿托伐他汀与CYP3A4酶抑制剂/诱导剂联合使用的情况。方法:随机抽取某三甲医院2012年度心内科应用辛伐他汀和阿托伐他汀的病例各50份,应用SPSS18.0统计软件,对患者的一般状况、用药情况及化验指标进行统计分析,计算各项指标的平均值或比例。结果:本调查纳入100名患者,66%的患者在使用辛伐他汀或阿托伐他汀的同时使用CYP3A4酶抑制剂,其中,辛伐他汀占30%,阿托伐他汀占36%,平均联合用药时间为(7.04±0.29)d。联合使用的CYP3A4酶抑制剂药物有氨氯地平片、地尔硫片、雷尼替丁片、胺碘酮、银杏叶片;CYP3A4酶诱导剂药物主要有卡马西平和醋酸泼尼松龙片。辛伐他汀或阿托伐他汀与CYP3A4酶抑制剂联合使用频率远远多于与CYP3A4酶诱导剂联合使用频率。比较合用和无合用CYP3A4酶抑制剂患者的主要生化指标,差异无统计学意义(P>0.05)。结论:辛伐他汀或阿托伐他汀与CYP3A4酶抑制剂联合使用情况在该医院较常见。建议尽量避免联用具有相互作用的药物,如必须使用,应按说明书要求不超剂量用药,并充分关注药物相互作用导致的不良反应,对患者后续情况定期随访。

Objective： To investigate the co-administration of simvastatin or atorvastatin with cytochrome P4503A4 （CYP3A4） inhibitors or inducers in clinical treatment. Methods： Fifty cases exposed to the co-administration of simvastatin or atorvastatin with CYP3A4 inhibitors or inducers were selected respectively at random in 2012 in cardiology ward of Beijing Hospital. The basic characteristics, clinical treatment information and laboratory indicators of patients were investigated. The average or proportion of relevant indicators of patients were calculated by SPSS18.0 software. Results： There were 100 patients included in the study. Sixty-six percent of the patients were prescribed simvastatin or atorvastatin with CYP3A4 inhibitors, among which the patients used simvastatin accounted for 30% and atorvastatin accounted for 36%. The average duration of concomitant medication use were （7.04 ~ 0.29） days. The CYP3A4 inhibitors that usually combined with simvastatin or atorvastatin were amlodipine, diltiazem, ranitidine, amiodarone, and ginkgo; while the CYP3A4 inducers were carbamazepine, prednisolone acetate tablets. The combination of simvastatin or atorvastatin with CYP3A4 inhibitors was more frequently than that with CYP3A4 inducers. There was no significant difference （P 〉 0.05） when comparing the biochemical indicators of patients who used statins combined with inhibitors or not. Conclusion： The co-prescription of simvastatin or atorvastatin with CYP3A4 inhibitors is common in the hospital. Strategies should be taken to avoid co-administration of simvastatin or atorvastatin with CYP3A4 inhibitors or inducers. If it must be used, drug dosage should be limited according to the direction of drug. We should pay attention to the drug interactions with potential adverse effects, and follow-up patients＇ condition at regular intervals.