Oberhoffer Felix Sebastian, Rieger Eva, Schenk Sara, Hauer Julia, Chmiel Ruth, Steinhauser Maximilian
Department of Pediatrics, TUM University Hospital/Munich Municipal Hospital Group, Munich, Germany.
Transl Pediatr. 2025 Apr 30;14(4):763-768. doi: 10.21037/tp-2025-30. Epub 2025 Apr 24.
Familial hypercholesterolemia (FH) is a genetic disorder that significantly increases low-density lipoprotein cholesterol (LDL-C) levels. Statins are commonly prescribed to minors to improve overall cardiovascular outcomes. Despite their well-documented efficacy in lowering lipid levels, statins can cause adverse side effects, including myopathy and, in rare cases, rhabdomyolysis.
A 17-year-old male adolescent presented with acute muscle pain in both arms. The patient had a history of FH and was undergoing treatment with rosuvastatin. Laboratory results revealed a marked elevation in creatine kinase (CK), myoglobin, cystatin C, and hepatic enzymes. Urinalysis did not show any abnormalities. Given the suspicion of statin-associated rhabdomyolysis, rosuvastatin was promptly discontinued. Further, the patient was administered intravenous fluids (3 L/m/day) for renal protection. Nine days after admission, levels of CK, myoglobin, and creatinine returned to normal. Hepatic enzymes and cystatin C remained elevated. The patient was advised to discontinue statin therapy for a total of 6 weeks. For further treatment, the patient was referred to a pediatric lipid clinic.
While the use of statins is generally safe, rare side effects including rhabdomyolysis must be detected and therapy promptly initiated to prevent long-term health effects. Patients that experienced statin-associated rhabdomyolysis should be monitored closely and referred to a pediatric lipid clinic for further treatment.
家族性高胆固醇血症（FH）是一种遗传性疾病，可显著升高低密度脂蛋白胆固醇（LDL-C）水平。他汀类药物通常用于未成年人，以改善整体心血管结局。尽管他汀类药物在降低血脂水平方面的疗效已得到充分证明，但它们可能会引起不良反应，包括肌病，在极少数情况下还会导致横纹肌溶解。
一名17岁男性青少年因双臂急性肌肉疼痛就诊。该患者有FH病史，正在接受瑞舒伐他汀治疗。实验室检查结果显示肌酸激酶（CK）、肌红蛋白、胱抑素C和肝酶显著升高。尿液分析未显示任何异常。鉴于怀疑为他汀类药物相关的横纹肌溶解，瑞舒伐他汀立即停用。此外，为保护肾脏，给予患者静脉输液（3升/天）。入院九天后，CK、肌红蛋白和肌酐水平恢复正常。肝酶和胱抑素C仍升高。建议患者总共停用他汀类药物治疗6周。为进一步治疗，患者被转诊至儿科血脂诊所。
虽然他汀类药物的使用总体上是安全的，但必须检测包括横纹肌溶解在内的罕见副作用，并立即开始治疗以防止长期健康影响。经历过他汀类药物相关横纹肌溶解的患者应密切监测，并转诊至儿科血脂诊所进行进一步治疗。
