Upreti Sunita, Fayyaz Beenish, Bongu Ramchandran P
Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA.
J Community Hosp Intern Med Perspect. 2019 Feb 11;9(1):33-35. doi: 10.1080/20009666.2019.1571882. eCollection 2019.
Statins are commonly used lipid lowering agents which play a pivotal role in reducing cardiovascular morbidity and mortality. Often well tolerated, these HMG-CoA reductase (HMGCR) inhibitors can sometimes cause severe muscle weakness and elevated creatinine kinase (CK) often labeled as statin intolerance or statin induced myopathy. These symptoms improve after discontinuation of the offending drug along with normalization of the enzyme levels. However, an entity called Immune Mediated Necrotizing Myopathy (IMNM), a type of autoimmune mediated myopathy, has been recognized and characterized in patients with history of statin exposure where there is persistence of proximal muscle weakness, CK elevation and myofiber necrosis can be seen on muscle biopsy even after stopping statins. With the increased use of statins, there seems to be a higher incidence of IMNM cases in recent years. Here we discuss a case of anti-HMG-CoA myopathy, one of the three recognized types of IMNM that has been more commonly associated with statin exposure and highly responsive to immunotherapy.
他汀类药物是常用的降脂药物，在降低心血管发病率和死亡率方面起着关键作用。这些HMG-CoA还原酶（HMGCR）抑制剂通常耐受性良好，但有时会导致严重的肌肉无力和肌酸激酶（CK）升高，常被称为他汀不耐受或他汀诱导的肌病。停用相关药物后，这些症状会改善，酶水平也会恢复正常。然而，一种名为免疫介导坏死性肌病（IMNM）的疾病，一种自身免疫介导的肌病，已在有他汀类药物暴露史的患者中得到认识和表征，即使在停用他汀类药物后，仍存在近端肌肉无力、CK升高，且肌肉活检可见肌纤维坏死。随着他汀类药物使用的增加，近年来IMNM病例的发病率似乎有所上升。在此，我们讨论一例抗HMG-CoA肌病病例，这是已被确认的三种IMNM类型之一，更常与他汀类药物暴露相关，且对免疫治疗高度敏感。
