Cadranel Jean-François, Seddik Mimouna, Loric Sylvia, Jeanne Sandrine
Service d'Hépato-Gastroentérologie et nutrition, Centre hospitalier Laennec, BP 72, 60109 Creil Cedex, France.
Presse Med. 2009 May;38(5):717-25. doi: 10.1016/j.lpm.2008.05.022. Epub 2008 Dec 25.
Statins are among the most widely prescribed drugs throughout the industrialized world. Their benefits in primary and secondary prevention of cardiovascular events are undeniable. An asymptomatic increase in aminotransferase levels, generally less than 3 times the upper limit of normal range, is often observed in patients receiving statins. It is dose-dependent and often regresses even though treatment continues. A significant increase in aminotransferase levels is very rare in patients receiving statins Cases of hepatocellular, cholestatic, and mixed pattern liver injuries have been described, but severe hepatitis is rare. Cases mimicking autoimmune hepatitis have been described. There is usually no cross hepatotoxicity between the different statins. When indicated, statins may be used in patients with nonalcoholic fatty liver, chronic viral hepatitis or compensated cirrhosis. Statins should not be used in patients with decompensated cirrhosis.
他汀类药物是工业化国家中处方最广泛的药物之一。它们在心血管事件一级和二级预防中的益处是不可否认的。接受他汀类药物治疗的患者中，常观察到氨基转移酶水平无症状性升高，一般低于正常范围上限的3倍。这种情况与剂量相关，即使继续治疗也常可自行消退。接受他汀类药物治疗的患者中，氨基转移酶水平显著升高非常罕见。肝细胞性、胆汁淤积性和混合型肝损伤病例均有报道，但严重肝炎罕见。也有类似自身免疫性肝炎的病例报道。不同他汀类药物之间通常不存在交叉肝毒性。有指征时，他汀类药物可用于非酒精性脂肪性肝病、慢性病毒性肝炎或代偿期肝硬化患者。失代偿期肝硬化患者不应使用他汀类药物。
