复方甘草酸苷致低血钾与横纹肌溶解1例并文献分析

One case of hypokalemia and rhabdomyolysis induced by compound glycyrrhizin and literature analysis

目的:回顾分析复方甘草酸苷在临床应用过程中致低血钾或横纹肌溶解的发病特点,为临床安全用药提供参考。方法:报告1例应用复方甘草酸苷片致严重低血钾及横纹肌溶解的病例,并检索2018年9月30日前中国知网(CNKI)、万方数据库、中文科技期刊数据库(VIP)报道的相关病例,共计22例,结合本例报道,对患者的性别、年龄、原患疾病、不良反应发生时间、转归等情况进行总结分析。结果:23例患者中,发生低血钾21例,横纹肌溶解8例(血钾均值1.88 mmol·L^(-1),2例未记录血钾水平);男女比例2.3∶1;平均年龄51岁;用药原因以肝脏疾病(69.6%)、皮肤病(21.7%)为主;复方甘草酸苷注射剂致低血钾及横纹肌溶解平均出现于用药后6 d(2 h～15 d),口服制剂致低血钾及横纹肌溶解平均出现于用药后52 d(7～180 d);所有病例预后良好。结论:复方甘草酸苷致低血钾或横纹肌溶解易发于中老年男性,临床应提高认识,并加强监测。

Objective: To analyze the characteristics of hypokalemia and rhabdomyolysis induced by compound glycyrrhizin in order to provide references for safe drug use in clinic. Methods: One case of compound glycyrrhizin induced hypokalemia and rhabdomyolysis reported here and 22 cases of compound glycyrrhizin induced hypokalemia and rhabdomyolysis reported in CNKI, Wanfang database and VIP database up to 30th September, 2018 were analyzed in terms of sex, age and original diseases of the patient as well as onset time, clinical characteristics and outcomes of adverse reaction. Results: A total of 23 cases were analyzed. 21 cases were suffered from hypokalemia. 8 cases were suffered from rhabdomyolysis, which had a mean serum K+ value of 1.88 mmol·L^-1 except 2 cases without record of the serum K^+ level. The ratio of male to female was 2.3 : 1. The average age was 51 years old. Compound glycyrrhizin was mainly used for hepatitis (69.6%) and skin diseases (21.7%). The onset time of hypokalemia or rhabdomyolysis induced by compound glycyrrhizin injection was ranged from 2 h to 15 d with a mean onset time of 6 d while that of the oral preparation of compound glycyrrhizin was ranged from 7 d to 180 d with a mean onset time of 52 d. All cases got fully recovery. Conclusion: Compound glycyrrhizin induced hypokalemia or rhabdomyolysis was more frequently found in elderly males, which should be more aware of and monitored.