From the Naval Health Clinic New England, Portsmouth, NH, USA.
J Am Board Fam Med. 2020 Sep-Oct;33(5):785-788. doi: 10.3122/jabfm.2020.05.190450.
Cardiovascular disease is a leading cause of morbidity and mortality in the United States. Since their initial discovery, statins have become the first-line treatment for decreasing the risk of cardiovascular disease. Although they are typically well tolerated, side effects do occur and tend to affect the musculature. Most side effects are benign and resolve after discontinuing the statin. A subset of immune-mediated necrotizing myositis, anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) myopathy is a rare disease that occurs in 0.9 to 1.4 cases per 100,000 people. It causes significant muscle weakness that does not resolve with discontinuation of the statin. Unlike other known complications, it has a late onset, occurring years after the statin was initially prescribed. It can also present in patients previously treated with statins who have not taken them for several years. This case report details the case of a 54-year-old woman who developed anti-HMGCR myopathy after several years of uncomplicated statin use. Differences between other reported cases and this 1 are discussed, including the patient's strong response to steroid therapy which resulted in the normalization of her serum creatinine kinase and alleviation of her muscle weakness. This case highlights the need for clinicians to be aware of anti-HMGCR myopathy and to consider it as a potential cause of proximal muscle weakness and persistent serum creatinine kinase elevations in patients exposed to statins even if they were previously well tolerated by the patient.
心血管疾病是美国发病率和死亡率的主要原因。自最初发现以来，他汀类药物已成为降低心血管疾病风险的一线治疗方法。尽管它们通常耐受性良好，但确实会出现副作用，并且往往会影响肌肉。大多数副作用是良性的，并在停止使用他汀类药物后消失。一部分免疫介导的坏死性肌炎，抗 3-羟基-3-甲基戊二酰辅酶 A 还原酶（HMGCR）肌病是一种罕见疾病，每 100,000 人中发生 0.9 至 1.4 例。它会导致严重的肌肉无力，即使停止使用他汀类药物也无法解决。与其他已知并发症不同，它的发病较晚，在他汀类药物最初开出处方几年后才出现。它也可能发生在已接受他汀类药物治疗但已数年未服用他汀类药物的患者中。本病例报告详细介绍了一位 54 岁女性在使用他汀类药物多年且无并发症后发生抗 HMGCR 肌病的情况。讨论了该病例与其他报告病例之间的差异，包括患者对类固醇治疗的强烈反应，这导致其血清肌酸激酶正常化并缓解了肌肉无力。本病例强调了临床医生需要意识到抗 HMGCR 肌病，并将其视为暴露于他汀类药物的患者出现近端肌肉无力和持续血清肌酸激酶升高的潜在原因，即使患者以前对其耐受良好。
