循证证据比较他汀类药物的获益与肌病相关风险的新进展

Compared Benefits and Risks of Muscle Related Disease of Statins with Evidence to Evidence

以指南和循证医学证据为基础,对他汀类药物的获益与肌病、横纹肌溶解等风险进行综述。提出他汀类药物的化学结构特征与类效应、异质性密切相关。明确了高强度应用他汀(阿托伐他汀、瑞舒伐他汀)用于动脉粥样硬化心血管疾病的一级和二级预防可给患者带来更多临床获益。尽管瑞舒伐他汀在同类药物中药理作用较强,但是由于磺酰胺基团的存在导致其毒性增大,国外循证证据表明,瑞舒伐他汀的横纹肌溶解风险明显高于阿托伐他汀等其他他汀类药物。因此,对于存在危险因素的患者选择瑞舒伐他汀治疗时需谨慎用药,权衡效益风险比。近来瑞舒伐他汀导致肌病、横纹肌溶解的病例在全球有增多的趋势,应引起临床的高度关注。临床药师应从特殊病理生理状态、相互作用、药物基因组学等方面着手,总结分析其发生规律、研究其发病机制以保障患者的用药安全,以承担起临床药师义不容辞的责任。

This paper reviewed benefit and risk of myopathy and rhabdomyolysis in statins with guide and following the medical evi- dence. The chemical structure of statins is closely related to the effect and heterogeneity of the drugs. The use of statins including atorvastatin, rosuvastatin can give patients more clinical benefit when strengthen to low blood lipid. Although rosnvastatin in statins is strongest, but presence of sulphonamide group resuhed in the increase of its toxicity, It show that rosuvastatin risk for rhabdomyolysis was significantly higher than that of atorvastatin statins by foreign evidence. Therefore, the patients following with multiple risk factors need to use caution with the choice of rosuvastatin. Recently rosuvastatin causing myopathy and rhabdomyolysis cases in the world has increased, It should arouse the attention of clinical. Clinical pharmacists should focus more on pathophysiological state, interaction, drug genome science to proceed, so we can summarize and analyze the occurrence regularity, and investigate its mechanism in order to protect the safety of patients with medication. It can help clinical pharmacists to take responsibility for the uprising.