辛伐他汀相关肌酸激酶升高和肝功能异常

1例88岁男性患者，因急性冠脉综合征联合使用氯吡格雷、阿司匹林、酒石酸美托洛尔、替米沙坦、辛伐他汀、达肝素钠、硝酸甘油。第5天辛伐他汀剂量由20mg，每晚1次增至40mg，每晚1次。第8天停用替米沙坦，给予口服地尔硫革15mg，3次／d和苯磺酸氨氯地平。第42天患者出现骨骼肌极度乏力伴肌痛。实验室检查：肌酸激酶（CK）8100U／L，肌酸激酶同工酶305U／L，肌钙蛋白0．046斗g／L，丙氨酸转氨酶（ALT）102U／L，天冬氨酸转氨酶（AST）151U／L。停用辛伐他汀并静脉滴注硫普罗宁。停药第16天复查血生化：CK55U／L，ALT13U／L，AST14U／L。8天后再次联合应用辛伐他汀10mg，每晚1次与地尔硫革30mg，3次／d，应用22天未见CK和肝功能异常。

Creatine kinase elevations and abnormal hepatic function associated with simvastatin

An 88-year-old male, received clopidogrel sulfate, aspirin, metoprolol tartrate, telmisartan, simvastatin, dalteparin sodium and nitroglycerin for acute coronary syndrome. On day 5 of treatment, the dosage of simvastatin was increased from 20 mg every night to 40 mg every night. On day 8, telmisartan was stopped and amlodipine besylate and dihiazem 15 mg thrice daily were added. On day 42, the patient developed severe skeletal muscular weakness and myalgia. Laboratory tests revealed the following levels： ereatine kinase（CK） 8100 U/L, creatine kinase-MB 305 U/L, troponin 0. 046 p.g/L, alanine aminotransferase （ALT） 102 U/L, aspartate aminotransferase （AST） 151 U/L. Simvastatin was stopped and he was given by an IV infusion of tiopronin. On day 16 of simvastatin withdrawal, repeat biochemical blood tests revealed the following levels： CK 55 U/L, ALT 13 U/L, and AST 14 U/L. Eight days later, simvastatin 10rag every night was administered again combined with diltiazem 30 mg thrice daily. Abnormalities of CK and liver function tests were not seen with a 22-day of treatment.