他汀类药物引起的肝损害

他汀类药物是3-羟基3-甲基戊二酰辅酶A还原酶抑制剂,是目前临床上广泛应用的降脂药物。他汀类药物所致肝损害(SILI)无特殊临床特征,与其他药物所致肝损害类似。SILI以肝细胞型多见,胆汁淤积型不常见,混合型少见。SILI的发生机制可能与药物本身的毒性、继发性效应及免疫机制等有关。高剂量、联合用药、肝病史等是SILI的危险因素。应用他汀类药物期间发生轻度肝损害者可减小药物剂量继续使用;发生中度肝损害者应在减量的同时使用保肝药物;发生严重肝损害者则需停药并采取相应的对症治疗措施。临床医师处方他汀类药物要注意严格掌握用药剂量,加强用药期间的实验室监测,尽量避免联合用药,并应嘱咐患者加强营养、注意休息。肝病患者慎用他汀类药物。大部分患者的SILI是可逆的。

Statin-induced liver injury

Statins are hydroxymethyl glutarate coenzyme A reductase inhibitors,which have been used widely in clinical practice as lipid-lowering drugs currently.The clinical features of statin-induced liver injury(SILI) are not special and similar to that of other drug-induced liver injury.The hepatocellular type of SILI is more common,the cholestatic type is less common,and mixed type is rare.The mechanisms of SILI may be associated with toxicity of statins,secondary pharmacological effects of statins,immune mechanisms,and so on.The risk factors for SILI are high-dose,drug combination,a history of liver disease,etc.If the liver damage is mild,the drug dosage should be reduced and the drug is continued;if the liver damage is moderate,the drug dosage of statins should be reduced and hepatoprotective treatment should be given at the same time;if the liver damage is severe,statins should be stopped at once and symptomatic treatments should be given.During treatment with statins,clinicians should control strictly the dosage of statins,enhance laboratory monitoring,avoid drug combination,and tell the patients to improve nutritional status and pay attention to rest.Statins should be used with caution in patients with liver diseases.The SILI is reversible in most patients.