普伐他汀致老年患者横纹肌溶解症

1例78岁男性冠状动脉粥样硬化性心脏病患者间断服用普伐他汀(20 mg,1次/晚)和阿司匹林(100 mg,1次/d)4年,3个月前因"阵发性心前区不适、心悸、气短"来本院就诊,诊断为"冠心病",开始规律口服上述2种药物(剂量同前)。服药11周后患者无明显诱因出现全身肌肉疼痛、肢体无力,尿色深伴尿量减少。入院前1 d患者排便时出现胸闷、心悸、气短,休息后不能完全缓解。血生化检查示天冬氨酸转氨酶(AST)294 U/L,丙氨酸转氨酶(ALT)180 U/L,乳酸脱氢酶(LDH)677 U/L,羟丁酸脱氢酶(α-HBDH)720 U/L,肌酸激酶(CK)12 210 U/L,肌酸激酶同工酶(CK-MB)770 U/L。停用普伐他汀,予对症治疗。3 d后患者全身肌痛减轻,1周后肌痛消失;2周后血生化检查示AST 16 U/L,ALT 24 U/L,LDH 192 U/L,α-HBDH 225 U/L,CK72 U/L,CK-MB 1.3 U/L。随访3个月,症状无复发,心肌酶及肝酶均正常。

Pravastatin-induced rhabdomyolysis in an elderly patient

A 78-year-old male patient with coronary atherosclerotic heart disease intermittently took pravastatin 20 mg once every night and aspirin 100 mg once daily for 4 years.Three months ago,the patient presented to hospital with paroxysmal precordial discomfort,palpitations,and shortness of breath,and he was diagnosed with ＂coronary heart disease＂.The patient then began to regularly take the above-mentioned 2 drugs at the same dosage as before.Eleven weeks later,the patient developed generalized muscle pain,limb weakness,dark urine,and oliguria with no other apparent precipatating causes.One day before admission,when the patient defecated,he developed tight chest,palpitations,and shortness of breath,and these symptoms did not completely resolve despite rest.Biochemical blood tests revealed the following levels and values： aspartate aminotransferase（AST）294 U/L,alanine aminotransferase（ALT） 180 U/L,lactate dehydrogenase（LDH） 677 U/L,hydroxybutyrate dehydrogenase（α-HBDH） 720 U/L,creatine kinase（CK） 12 210 U/L,and creatine kinase isoenzyme（CK-MB） 770 U/L.Pravastatin was stopped and symptomatic treatments were given.The patient＇ s muscle pain relieved 3 days later,and disappeared 1 week later.Two weeks later,the biochemical blood tests showed the following results： AST 16 U/L,ALT 24U/L,LDH 192 U/L,α-HBDH 225 U/L,CK 72 U/L,and CK-MB 1.3 U/L.The patient＇s symptoms did not recur,and his myocardial enzymes and liver enzymes were within normal ranges at a three-month follow-up.