氟伐他汀致转氨酶升高并横纹肌溶解1例

1例79岁女性患者因冠心病给予氟伐他汀,同时给予阿司匹林、氯吡格雷、富马酸比索洛尔、单硝酸异山梨酯治疗。2月后出现双下肢无力伴疼痛、食欲不振,实验室检查：肌酸激酶（CK）50 774 U·L-1,丙氨酸转氨酶（ALT）706.9 U·L-1,天门冬氨酸转氨酶 (AST) 1 294 U·L-1。停用氟伐他汀,继续使用其他药物,并给予硫普罗宁及水飞蓟宾葡甲胺保肝治疗。次日复查CK 38 134 U·L-1。停药5 d后下肢无力症状消失,7 d后CK 2144,ALT 494.6,AST 189 U·L-1。1个月及3个月后随访,转氨酶及心肌酶均基本恢复正常。

Fluvastatin-induced hepatic enzyme elevation and rhabdomyolysis

A 79-year-old female patient with coronary heart disease received fluvastatin, meanwhile she was given aspirin, hydroclopidogrel, bisoprolol fumarate and isosorbide mononitrate. The patient developed weakness and pain in double lower limbs with loss of appetite two months after the first dose. Laboratory tests showed creatine kinase (CK) 50 774 U·L-1, alanine aminotransferase (ALT) 706.9 U·L-1, aspartate aminotransferase (AST) 1 294 U·L-1. Fluvastatin was withdrawn and other drugs continued. Meanwhile tiopronin and silibin meglumine were given for liver protection treatment. Laboratory tests showed CK 38 134 U·L-1 in the next day. After 5 days of fluvastatin withdrawn, the lower limbs weakness disappeared. Seven days after withdrawn, laboratory tests showed CK 2144 U·L-1, ALT 494.6 U·L-1, AST 189 U·L-1. Both hepatic transaminase and myocardial enzyme basically returned to normal at one month and three months of follow-up after withdrawn.