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常规护理环境下他汀类药物引起的肌病——一项关于性别差异的前瞻性观察研究

Statin-induced myopathy in a usual care setting-a prospective observational study of gender differences.

作者信息

Skilving Ilona, Eriksson Mats, Rane Anders, Ovesjö Marie-Louise

机构信息

Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, 141 86, Stockholm, SE, Sweden.

Department of Endocrinology, Metabolism and Diabetes; Center for Biosciences, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86, Stockholm, SE, Sweden.

出版信息

Eur J Clin Pharmacol. 2016 Oct;72(10):1171-1176. doi: 10.1007/s00228-016-2105-2. Epub 2016 Aug 2.

Abstract

PURPOSE

The study aims to identify the occurrence and remission of statin-induced myopathy including patient perception and symptom characteristics with a gender perspective.

METHODS

The study was designed as a prospective, non-interventional investigation in 192 outpatients receiving statin treatment in usual care with 12 months follow-up. Main outcome measure was myopathy related to statin treatment and classified as probable using WHO criteria for adverse drug reaction (ADR) assessment.

RESULTS

Fourteen percent developed myopathy, risk ratio for women 1.52 [95 % CI 1.37; 1.66] as compared to men. The majority graded their pain as "severe." CK values were within normal range. Eighty percent of the women compared to 43 % of the men reported that the muscular symptoms affected their daily life activities to a moderate or severe extent. For those who stopped treatment, mypopathy was the reason for 70 % of the women and 25 % of the men. There was a difference in mean dose between men with and without myopathy, but not in women. Among the patients with myopathy, 76 % reported other ADRs as compared to 21 % of the patients without myopathy (p = 0.002). Twenty-nine percent of the women and 18 % of the men reported other ADRs.

CONCLUSION

Women reported a higher frequency of myopathy and other ADRs as well as a larger impact on daily life activities. In men, but not in women, the risk of myopathy was dose-dependent. Patients with myopathy were more susceptible to other statin-induced ADRs which raises the question about common underlying mechanisms.

摘要

目的

本研究旨在从性别角度确定他汀类药物所致肌病的发生和缓解情况,包括患者的感知和症状特征。

方法

本研究设计为一项前瞻性、非干预性调查,对192名在常规治疗中接受他汀类药物治疗的门诊患者进行为期12个月的随访。主要结局指标是与他汀类药物治疗相关的肌病,并根据世界卫生组织药物不良反应(ADR)评估标准分类为可能的肌病。

结果

14%的患者发生了肌病,女性发生肌病的风险比男性高1.52[95%可信区间1.37;1.66]。大多数患者将疼痛评为“严重”。肌酸激酶(CK)值在正常范围内。80%的女性和43%的男性报告肌肉症状对其日常生活活动有中度或重度影响。对于那些停止治疗的患者,70%的女性和25%的男性停药原因是肌病。有肌病和无肌病男性的平均剂量存在差异,但女性不存在此差异。在有肌病的患者中,76%报告有其他ADR,而无肌病患者中这一比例为21%(p = 0.002)。29%的女性和18%的男性报告有其他ADR。

结论

女性报告的肌病和其他ADR发生率更高,对日常生活活动的影响也更大。在男性中,而非女性中,肌病风险与剂量有关。有肌病的患者更容易发生其他他汀类药物所致的ADR,这引发了关于共同潜在机制的问题。

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