Evangelista Teresinha, Ferro José, Pereira Pedro, de Carvalho Mamede
Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
Neuromuscul Disord. 2009 Jan;19(1):66-8. doi: 10.1016/j.nmd.2008.10.008. Epub 2008 Dec 11.
There are only a few reports on the effect of statins over diseased muscle and none in cytoplasmic body myopathy. This is a heterogeneous entity that can be asymptomatic until late in life and is characterized by the presence of numerous cytoplasmic bodies in muscle biopsy. A 74-years-old male received statin treatment on two separate occasions, first with sinvastatin and afterwards with rosuvastatin. In both cases, he experienced diffuse myalgia, lower limbs weakness and respiratory fatigue and improved after interruption of each treatment course. Electromyography has shown signs of muscle necrosis, serum creatine kinase (CK) concentration was increased and muscle biopsy revealed numerous cytoplasmic bodies. To our knowledge this is the first report of statin-related muscle necrosis in a patient with CBM. According to the literature neuropathological features of statin myopathy do not include the presence of cytoplasmic bodies so we assume that cytoplasmic body myopathy was asymptomatically present before statin treatment. This case supports the role of muscle biopsy in patients that develop muscular necrosis while on statin treatment.
关于他汀类药物对病变肌肉影响的报道较少，而关于胞质体肌病的报道则尚无。胞质体肌病是一种异质性疾病，在生命晚期之前可能无症状，其特征是肌肉活检中存在大量胞质体。一名74岁男性曾两次接受他汀类药物治疗，先是辛伐他汀，后是瑞舒伐他汀。在这两种情况下，他都出现了弥漫性肌痛、下肢无力和呼吸疲劳，每次治疗疗程中断后症状有所改善。肌电图显示有肌肉坏死迹象，血清肌酸激酶（CK）浓度升高，肌肉活检发现大量胞质体。据我们所知，这是关于胞质体肌病患者出现他汀类药物相关肌肉坏死的首例报告。根据文献，他汀类药物肌病的神经病理特征不包括胞质体的存在，因此我们推测在他汀类药物治疗前胞质体肌病就已无症状存在。该病例支持了肌肉活检在他汀类药物治疗期间发生肌肉坏死患者中的作用。
