Nichols Laura, Pfeifer Kurt, Mammen Andrew L, Shahnoor Nazima, Konersman Chamindra G
Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Neurology, Johns Hopkins University School of Medicine Baltimore, Baltimore, MD, USA.
J Gen Intern Med. 2015 Dec;30(12):1879-83. doi: 10.1007/s11606-015-3303-9. Epub 2015 Apr 9.
Statins are some of the most widely prescribed medications, and though generally well tolerated, can lead to a self-limited myopathy in a minority of patients. Recently, these medications have been associated with a necrotizing autoimmune myopathy (NAM). Statin-associated NAM is characterized by irritable myopathy on electromyography (EMG) and muscle necrosis with minimal inflammation on muscle biopsy. The case presented is a 63-year-old woman who has continued elevation of creatine kinase (CK) after discontinuation of statin therapy. She has irritable myopathy on EMG and NAM is confirmed by muscle biopsy. She subsequently tests positive for an experimental anti-3-hydroxy-3-methylglutaryl-coenzyme A (anti-HMGCoA) antibody that is found to be present in patients with statin-associated NAM. Though statin-associated NAM is a relatively rare entity, it is an important consideration for the general internist in patients who continue to have CK elevation and weakness after discontinuation of statin therapy. Continued research is necessary to better define statin-specific and dose-dependent risk, as well as optimal treatment for this condition.
他汀类药物是处方最广泛的药物之一，虽然一般耐受性良好，但在少数患者中可导致自限性肌病。最近，这些药物与坏死性自身免疫性肌病（NAM）有关。他汀类药物相关的NAM的特征是肌电图（EMG）显示易激惹性肌病，肌肉活检显示肌肉坏死且炎症轻微。所呈现的病例是一名63岁女性，在停用他汀类药物治疗后肌酸激酶（CK）持续升高。她的肌电图显示易激惹性肌病，肌肉活检证实为NAM。随后她检测出一种实验性抗3-羟基-3-甲基戊二酰辅酶A（抗HMGCoA）抗体呈阳性，该抗体在他汀类药物相关的NAM患者中被发现。虽然他汀类药物相关的NAM是一种相对罕见的病症，但对于在停用他汀类药物治疗后CK持续升高且伴有肌无力的患者，普通内科医生应予以重视。有必要继续开展研究，以更好地界定他汀类药物特异性和剂量依赖性风险，以及针对这种病症的最佳治疗方法。
