非诺贝特致甲状腺功能减低患者横纹肌溶解症1例

1例37a男性患者,因血脂高,给予非诺贝特缓释胶囊250mg,口服,每晚1次。服药前查：TG17.17mmol·L-1,CK45U·L-1,LDH98U·L-1,AST30IU·L-1,ALT21IU·L-1。服药第9天后患者出现右侧小腿肌肉酸痛、无力,急查CK2900.05U·L-1,LDH432U·L-1,AST121IU·L-1,ALT65.5IU·L-1,确诊为横纹肌溶解症。立即停用非诺贝特,给予碱化尿液、保护细胞膜等治疗。查甲状腺功能示：TT30.3nmol·L-1,TT47.5nmol·L-1,FT31.9pmol·L-1,FT47.8pmol·L-1,TSH237μIU·mL-1。甲状腺B超示甲状腺弥漫性病变。确诊为甲状腺功能减低,遂加用口服左甲状腺素钠片治疗。停非诺贝特3d后患者症状消失,27d后血CK、转氨酶基本恢复。

One case of rhabdomyolysis caused by fenofibrate in a patient with hypothyroidism

A 37-year-old man was given oral fenofibrate sustained release capsules 250 mg every night for the treatment of hyperlipidemia.Before the treatment,laboratory examinations showed the following values：TG 17.17 mmol·L-1,CK 45 U·L-1,LDH 98 U·L-1,AST 30 IU·L-1,ALT 21 IU·L-1.After 9 days of the treatment,he developed the right cruris muscular soreness and hypodynamia.The laboratory examinations revealed：CK 2900.05 U·L-1,LDH 432 U·L-1,AST 121 IU·L-1,ALT 65.5 IU·L-1.He was diagnosed with rhabdomyolysis.Fenofibrate was stopped immediately.The patient was treated with urine alkalinization and protection of cell membrane.The thyroid gland function test showed：TT3 0.3 nmol·L-1,TT4 7.5 nmol·L-1,FT3 1.9 pmol·L-1,FT4 7.8 pmol·L-1 and TSH 237 μIU·mL-1.Diffuse thyroid disease was found by the ultrasound of thyroid gland.He was diagnosed with hypothyroidism and given oral levothyroxine tablets.Three days later,his symptom disappeared.Twenty-seven days later,the level of creatinine phosphokinases and transaminases nearly returned to normal.