Mirlesse Nicolas, Egervari Kristof, Bornand Aurélie, Lecluse Julien, Lobrinus Johannes A, Scheffler Max, Serratrice Christine, Prendki Virginie, Cuvelier Clémence
Department of Internal Medicine of the Aged, Trois-Chêne Geneva University Hospital, Geneva, Switzerland.
Service of Clinical Pathology, Department of Genetic Medicine, Laboratory and Pathology, Geneva University Hospital, Geneva, Switzerland.
Age Ageing. 2020 Aug 24;49(5):883-884. doi: 10.1093/ageing/afaa038.
Statins are widely prescribed in the treatment of hypercholesterolemia. While their efficacy in the secondary prevention of vascular events is proven, their safety profile in older patients with multiple co-morbidities and polypharmacy remains questionable. Although rare, antihydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) myopathy is a severe adverse effect of statins, manifesting as myalgias, proximal muscle weakness, muscle cell necrosis and rhabdomyolysis. We report an uncommon case of an autopsy-proven anti-HMGCR necrotising myopathy predominately affecting pharyngeal muscles in an older patient, leading to dysphagia, pneumonia and death within 3 weeks from onset. Clinicians should screen for dysphagia in any patient with suspected anti-HMGCR myopathy, order an anti-HMGCR antibody titre and consider prompt immunosupressive therapy.
他汀类药物被广泛用于治疗高胆固醇血症。虽然它们在血管事件二级预防中的疗效已得到证实，但在患有多种合并症和同时服用多种药物的老年患者中的安全性仍存在疑问。抗羟甲基戊二酰辅酶A还原酶（抗HMGCR）肌病虽然罕见，但却是他汀类药物的一种严重不良反应，表现为肌痛、近端肌无力、肌肉细胞坏死和横纹肌溶解。我们报告了一例经尸检证实的抗HMGCR坏死性肌病的罕见病例，该病例主要影响一名老年患者的咽部肌肉，导致吞咽困难、肺炎，并在发病后3周内死亡。临床医生应在任何疑似抗HMGCR肌病的患者中筛查吞咽困难，检测抗HMGCR抗体滴度，并考虑及时进行免疫抑制治疗。
