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瑞舒伐他汀所致肌病:病例系列

Rosuvastatin-Induced Myopathy: A Case Series.

作者信息

Malani Susheel K, Chigullapalli Sridevi, Sujanyal Saurabh, Sharma Vijay

机构信息

Cardiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND.

Medicine and Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND.

出版信息

Cureus. 2024 Aug 5;16(8):e66180. doi: 10.7759/cureus.66180. eCollection 2024 Aug.

DOI:10.7759/cureus.66180
PMID:39233949
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11373368/
Abstract

Statins are one of the most crucial drugs used for the prevention of atherosclerotic coronary artery disease. A wide spectrum of symptoms ranging from myalgia to symptoms of rhabdomyolysis with or without weakness of the upper and lower limbs are indicative of statin-induced rhabdomyolysis or myopathy. The current case series which represents three patients who developed statin-induced myopathy after starting rosuvastatin is one of a few if not the first case series. All three patients had recently started rosuvastatin 40mg once daily post-percutaneous transluminal coronary angioplasty (PTCA) for secondary prevention of atherosclerotic cardiovascular diseases (ASCVDs). Shortly after starting the medication, they were hospitalized due to bilateral lower limb pain and weakness. On further evaluation, they were diagnosed to have rosuvastatin-induced myopathy with acute kidney injury and/or liver injury. In all cases, myopathy, acute renal injury, and liver injury were caused by rosuvastatin, regardless of the presence of a vitamin D deficiency. Despite the documented risk of myopathy and renal toxicity associated with rosuvastatin, the drug remains highly popular worldwide in the modern period. Although all the cases discussed were successfully treated by stopping rosuvastatin and switching it with another class of lipid-lowering agent, it significantly increased morbidity and raised medical expenses. Hence, this case series not only adds to existing safety disputations associated with rosuvastatin but also calls for more pharmacovigilance when recommending this medication.

摘要

他汀类药物是预防动脉粥样硬化性冠状动脉疾病最关键的药物之一。从肌痛到横纹肌溶解症状,无论有无上肢和下肢无力,一系列广泛的症状都提示他汀类药物引起的横纹肌溶解或肌病。本病例系列代表了3例在开始服用瑞舒伐他汀后发生他汀类药物引起的肌病的患者,即便不是首个病例系列,也是为数不多的病例系列之一。所有3例患者均在经皮腔内冠状动脉成形术(PTCA)后最近开始每日一次服用40mg瑞舒伐他汀,用于动脉粥样硬化性心血管疾病(ASCVD)的二级预防。开始用药后不久,他们因双侧下肢疼痛和无力住院。进一步评估后,他们被诊断为瑞舒伐他汀引起的肌病,并伴有急性肾损伤和/或肝损伤。在所有病例中,无论是否存在维生素D缺乏,肌病、急性肾损伤和肝损伤均由瑞舒伐他汀引起。尽管有记录表明瑞舒伐他汀存在肌病和肾毒性风险,但在现代,该药物在全球范围内仍然非常受欢迎。虽然所讨论的所有病例通过停用瑞舒伐他汀并换用另一类降脂药物成功得到治疗,但这显著增加了发病率并提高了医疗费用。因此,本病例系列不仅增加了与瑞舒伐他汀相关的现有安全性争议,也在推荐使用这种药物时呼吁加强药物警戒。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc49/11373368/c43c4ec8da6d/cureus-0016-00000066180-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc49/11373368/c43c4ec8da6d/cureus-0016-00000066180-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc49/11373368/c43c4ec8da6d/cureus-0016-00000066180-i01.jpg

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1
Rosuvastatin-Induced Myopathy: A Case Series.瑞舒伐他汀所致肌病:病例系列
Cureus. 2024 Aug 5;16(8):e66180. doi: 10.7759/cureus.66180. eCollection 2024 Aug.
2
Rosuvastatin-Induced Rhabdomyolysis: A Case Report.瑞舒伐他汀诱导的横纹肌溶解症:一例报告
Indian J Nephrol. 2021 Mar-Apr;31(2):190-193. doi: 10.4103/ijn.IJN_388_19. Epub 2021 Mar 27.
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Acute Kidney Injury and Quadriparesis Due to Rosuvastatin Induced Rhabdomyolysis- A Case Report.瑞舒伐他汀诱导横纹肌溶解导致急性肾损伤和四肢瘫——病例报告
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Clinical Rhabdomyolysis With Acute Kidney Injury Secondary to High-Intensity Rosuvastatin Use: A Case Report.高强度使用瑞舒伐他汀继发临床横纹肌溶解症伴急性肾损伤:一例报告
Cureus. 2020 Oct 13;12(10):e10932. doi: 10.7759/cureus.10932.
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The safety of rosuvastatin in comparison with other statins in over 100,000 statin users in UK primary care.在英国初级医疗保健中,超过10万名他汀类药物使用者中瑞舒伐他汀与其他他汀类药物相比的安全性。
Pharmacoepidemiol Drug Saf. 2008 Oct;17(10):943-52. doi: 10.1002/pds.1603.
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Statin-Associated Necrotizing Myopathy Leading to Acute Kidney Injury: A Case Report.他汀类药物相关性坏死性肌病导致急性肾损伤:一例报告
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Results of a safety initiative for patients on concomitant amiodarone and simvastatin therapy in a Veterans Affairs medical center.一家退伍军人事务医疗中心针对同时接受胺碘酮和辛伐他汀治疗的患者开展的安全倡议结果。
J Manag Care Pharm. 2010 Sep;16(7):472-81. doi: 10.18553/jmcp.2010.16.7.472.
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Results from a rosuvastatin historical cohort study in more than 45,000 Dutch statin users, a PHARMO study.一项针对超过45000名荷兰他汀类药物使用者的瑞舒伐他汀历史队列研究结果,即PHARMO研究。
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Rosuvastatin-associated adverse effects and drug-drug interactions in the clinical setting of dyslipidemia.瑞舒伐他汀在血脂异常临床治疗中的不良反应及药物相互作用。
Am J Cardiovasc Drugs. 2010;10(1):11-28. doi: 10.2165/13168600-000000000-00000.
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Statin-Associated Bilateral Foot Myopathy.他汀类药物相关双侧足部肌病。
J Pharm Pract. 2020 Dec;33(6):899-902. doi: 10.1177/0897190019857851. Epub 2019 Jun 27.

本文引用的文献

1
Risk of Statin-Induced Hypertransaminasemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.他汀类药物所致高转氨酶血症的风险:一项随机对照试验的系统评价和荟萃分析
Mayo Clin Proc Innov Qual Outcomes. 2019 May 5;3(2):131-140. doi: 10.1016/j.mayocpiqo.2019.01.003. eCollection 2019 Jun.
2
The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990-2016.印度各邦心血管疾病及其危险因素的变化模式:1990-2016 年全球疾病负担研究。
Lancet Glob Health. 2018 Dec;6(12):e1339-e1351. doi: 10.1016/S2214-109X(18)30407-8. Epub 2018 Sep 12.
3
Statins for primary prevention and rhabdomyolysis: A nationwide cohort study in France.
他汀类药物用于一级预防和横纹肌溶解症:法国全国队列研究。
Eur J Prev Cardiol. 2019 Mar;26(5):512-521. doi: 10.1177/2047487318776831. Epub 2018 May 25.
4
Immune-Mediated Necrotizing Myopathy.免疫介导性坏死性肌病。
Curr Rheumatol Rep. 2018 Mar 26;20(4):21. doi: 10.1007/s11926-018-0732-6.
5
Statin-induced myalgia and myositis: an update on pathogenesis and clinical recommendations.他汀类药物引起的肌肉疼痛和肌炎:发病机制和临床建议的更新。
Expert Rev Clin Immunol. 2018 Mar;14(3):215-224. doi: 10.1080/1744666X.2018.1440206. Epub 2018 Feb 23.
6
Renal effects of atorvastatin and rosuvastatin in patients with diabetes who have progressive renal disease (PLANET I): a randomised clinical trial.阿托伐他汀和瑞舒伐他汀在伴有进行性肾脏疾病的糖尿病患者中的肾脏作用(PLANET I):一项随机临床试验。
Lancet Diabetes Endocrinol. 2015 Mar;3(3):181-90. doi: 10.1016/S2213-8587(14)70246-3. Epub 2015 Feb 4.
7
Vitamin D status modifies the association between statin use and musculoskeletal pain: a population based study.维生素D状态改变他汀类药物使用与肌肉骨骼疼痛之间的关联:一项基于人群的研究。
Atherosclerosis. 2015 Jan;238(1):77-82. doi: 10.1016/j.atherosclerosis.2014.11.012. Epub 2014 Nov 20.
8
An assessment by the Statin Muscle Safety Task Force: 2014 update.他汀类药物肌肉安全性工作组评估:2014 年更新。
J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S58-71. doi: 10.1016/j.jacl.2014.03.004.
9
Predictors and outcomes of increases in creatine phosphokinase concentrations or rhabdomyolysis risk during statin treatment.他汀类药物治疗期间肌酸磷酸激酶浓度升高或横纹肌溶解风险的预测因素及结果
Br J Clin Pharmacol. 2014 Sep;78(3):649-59. doi: 10.1111/bcp.12367.
10
The spectrum of statin myopathy.他汀类药物肌病谱。
Curr Opin Rheumatol. 2013 Nov;25(6):747-52. doi: 10.1097/01.bor.0000434673.85515.89.