Clarke A T, Mills P R
Gastroenterology Unit, Gartnavel General Hospital, Glasgow, UK.
Dig Liver Dis. 2006 Oct;38(10):772-7. doi: 10.1016/j.dld.2006.04.013. Epub 2006 Jun 13.
Atorvastatin, a HMG-CoA reductase inhibitor, is widely used in the treatment of dyslipidaemia. A transient rise in serum transaminases occurs in up to 3% of patients using atorvastatin but this is usually self-limiting and inconsequential. Recent literature has indicated some potential for more serious but rare idiosyncratic reactions related to this drug. Seven patients with significant liver dysfunction from one centre during 2002-2005 are reported, with one death, that raises some concern over the safety of atorvastatin. A total of seven other patients are reported in the literature. The 14 patients were usually over 60 years, had a female:male ratio of 2:1 and showed a mixed cholestatic/hepatocellular reaction. The mean interval to onset of reaction was approximately 9 weeks and the liver often took several months to recover. Three deaths occurred. Adverse drug reaction reports from the UK Committee on Safety of Medicines reveal that four deaths due to hepatobiliary disease (0.5 deaths per annum) have been reported in association with atorvastatin treatment over 8 years. Simvastatin has had no hepatobiliary-related fatalities reported over 15 years. While acute hepatotoxicity with atorvastatin remains uncommon, any persistent abnormality in liver function should be treated with caution.
阿托伐他汀是一种HMG - CoA还原酶抑制剂，广泛用于治疗血脂异常。使用阿托伐他汀的患者中，高达3%会出现血清转氨酶短暂升高，但这通常是自限性的，且无关紧要。最近的文献表明，这种药物可能会引发一些更严重但罕见的特异反应。本文报告了2002年至2005年期间，一个中心的7例有严重肝功能障碍的患者，其中1例死亡，这引发了对阿托伐他汀安全性的一些担忧。文献中还报道了另外7例患者。这14例患者通常年龄超过60岁，男女比例为2:1，表现为胆汁淤积/肝细胞混合性反应。反应发生的平均间隔时间约为9周，肝脏通常需要数月才能恢复。有3例死亡。英国药品安全委员会的药物不良反应报告显示，在8年的阿托伐他汀治疗中，有4例因肝胆疾病死亡（每年0.5例）。辛伐他汀在15年中未报告有与肝胆相关的死亡病例。虽然阿托伐他汀引起的急性肝毒性仍然不常见，但任何肝功能的持续异常都应谨慎处理。
