他汀类药物相关肌病的特点及防治策略

Clinical Characteristics and Prevention Strategies of Statin-induced Myopathy

目的:研究他汀类药物相关肌病的临床特点、危险因素、防治策略。方法:收集我院2009年1月-2013年12月他汀类药物相关肌病44例为肌病组;同期同一病房原发病相同(均为冠心病或脑梗死患者)、同性别、服用同一类他汀类药物的北京地区患者44例为对照组。对两组患者在年龄、并发症、合并用药、药物剂量等方面的临床特点进行配对样本分析。结果:高龄、合并用药、甲状腺功能减低、肝功能不全或嗜酒史、大剂量用药是他汀类药物相关肌病的危险因素。结论:他汀类药物相关肌病的主要临床表现为肌痛、关节痛伴或不伴肌酶升高。服用大剂量他汀类药物、合并多种其他CYP3A4代谢药或致药源性横纹肌溶解药是他汀类药物相关肌病的最重要危险因素。采用合理的防治措施后他汀类药物相关肌病预后较好。

OBJECTIVE： To investigate the clinical characteristics, risk factors, prevention strategies of statin-induced myopa- thy. METHODS： 44 patients with statin-induced myopathy from Jan. 2009 to Dec. 2013 in our hospital were included in myopathy group; 44 same gender patients with same primary disease （coronary disease or cerebral infarction） receiving same statin in same ward were selected as control group. Clinical characteristics of 2 groups were analyzed comparatively in terms of age, complica- tion, drug combination, drug dosage, etc. RESULTS： The main risk factors of statin-induced myopathy were advanced age, drug combination, hypothyroidism, liver dysfunction or alcohol history, large doses of drugs. CONCLUSIONS： The main clinical mani- festations of statin-induced myopathy include myalgia, arthralgia with or without elevated muscle enzymes. The most important risk factors of statin-indueed myopathy contain a large dose of statins, combining with multiple CYP3A4 metabolism drugs or drug-in- duced rhabdomyolysis drugs. The good prognosis of statin-induced myopathy has been obtained after adopting reasonable prevention strategies.