Ruan Xu Cong, Low Lian Leng, Kwan Yu Heng
MD Candidate; Duke-NUS Medical School, Singapore.
Associate Consultant, Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.
J Prim Health Care. 2017 Dec;9(4):316-320. doi: 10.1071/HC17051.
INTRODUCTION The risk of rhabdomyolysis in the general population is elevated by the increased prevalence of statin use. As the presentation of rhabdomyolysis is varied, there is a risk of delayed diagnosis leading to patient complications and increased healthcare costs. Creatine kinase (CK) alone is not sufficiently predictive for risk stratification. Beyond serum CK, other biomarkers such as transaminases may be used as surrogates to evaluate rhabdomyolysis severity and predict complication risks. AIM To assess if other biomarkers are associated with peak CK and severity of rhabdomyolysis to aid in clinical diagnosis of rhabdomyolysis. METHODS A retrospective study was conducted at an acute care hospital from 2008 to 2011. Inclusion criteria were: (1) patients diagnosed with statin-induced rhabdomyolysis; and (2) peak CK levels of ≥1000 IU/L. Patients with post-operational rhabdomyolysis, acute myocardial infarction and who had suffered from road traffic accidents were excluded. A total of 24,332 patients were screened, and 78 patients fulfilled our inclusion criteria. RESULTS Aspartate aminotransferase (AST) was found to be positively associated with peak CK levels in the multivariable linear regression model after adjusting for alanine aminotransferase (ALT) levels (P = 0.002; β = 83.18). Aspartate aminotransferase was found to be associated with severity of rhabdomyolysis in the multivariable logistics regression model after adjusting for ALT levels (P = 0.015; OR = 1.01). DISCUSSION Aspartate transferase is associated with raised peak CK levels and severity of rhabdomyolysis. Clinicians may consider ordering AST to aid in the clinical diagnosis of rhabdomyolysis.
引言 他汀类药物使用的增加使得普通人群中横纹肌溶解症的风险升高。由于横纹肌溶解症的表现多样，存在诊断延迟的风险，这会导致患者出现并发症并增加医疗成本。仅肌酸激酶（CK）不足以预测风险分层。除了血清CK外，其他生物标志物如转氨酶可作为替代指标来评估横纹肌溶解症的严重程度并预测并发症风险。目的 评估其他生物标志物是否与横纹肌溶解症的CK峰值及严重程度相关，以辅助横纹肌溶解症的临床诊断。方法 2008年至2011年在一家急症医院进行了一项回顾性研究。纳入标准为：（1）诊断为他汀类药物引起的横纹肌溶解症的患者；（2）CK峰值水平≥1000 IU/L。排除术后横纹肌溶解症、急性心肌梗死及交通事故患者。共筛选了24332例患者，78例符合纳入标准。结果 在调整丙氨酸转氨酶（ALT）水平后的多变量线性回归模型中，发现天冬氨酸转氨酶（AST）与CK峰值水平呈正相关（P = 0.002；β = 83.18）。在调整ALT水平后的多变量逻辑回归模型中，发现天冬氨酸转氨酶与横纹肌溶解症的严重程度相关（P = 0.015；OR = 1.01）。讨论 天冬氨酸转氨酶与升高的CK峰值水平及横纹肌溶解症的严重程度相关。临床医生可考虑检测AST以辅助横纹肌溶解症的临床诊断。
