Tel Aviv University, Meir Medical Center, Kfar Saba, Israel.
Expert Opin Drug Saf. 2012 Mar;11(2):185-90. doi: 10.1517/14740338.2012.630659. Epub 2011 Nov 16.
Statin-treated patients undergo frequent laboratory tests. This study evaluated the clinical impact of abnormal liver or muscle enzyme results.
This clinical process evaluation study took place in six primary care clinics in Israel. Four hundred and eight patients (average age 63.8 ± 10.9 years) undergoing statin treatment, with at least one enzyme level > 10% normal, were categorized by symptomatology possibly related to statins. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and creatine phosphokinase were measured. Management and etiology of the elevation were assessed.
Changes in statin regimen.
Thirty-six (8.8%) patients were symptomatic at the index encounter. One enzyme was elevated in 74.8%. Patients experiencing side effects had more repeat tests (36.1 vs 17.7%, p < 0.001). Musculoskeletal symptoms resulted in a change in treatment more than digestive symptoms did (73.3 vs 16.7%, p < 0.001). Of 40 (9.8%) patients who had additional evaluation, two symptomatic patients had treatment changes.
There is little practical value in routine follow-up enzyme tests for patients on statins. Our findings strengthen reports that recommend muscle and liver enzyme tests for symptomatic patients only.
接受他汀类药物治疗的患者需要频繁进行实验室检查。本研究评估了异常肝或肌肉酶结果对临床的影响。
本临床流程评估研究在以色列的六家初级保健诊所进行。408 名（平均年龄 63.8 ± 10.9 岁）接受他汀类药物治疗的患者，至少有一项酶水平升高超过正常水平的 10%，根据可能与他汀类药物相关的症状进行分类。检测天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、碱性磷酸酶和肌酸磷酸激酶。评估升高的管理和病因。
他汀类药物治疗方案的变化。
36 名（8.8%）患者在就诊时出现症状。74.8%的患者有一项酶升高。出现副作用的患者进行了更多的重复检查（36.1%比 17.7%，p < 0.001）。肌肉骨骼症状导致治疗改变的比例高于消化症状（73.3%比 16.7%，p < 0.001）。在进行了额外评估的 40 名（9.8%）患者中，有两名有症状的患者改变了治疗方案。
对于服用他汀类药物的患者，常规进行后续酶检查几乎没有实际价值。我们的发现支持仅建议对有症状的患者进行肌肉和肝脏酶检查的报告。
