Outcomes in 45 patients with statin-associated myopathy
Outcomes in 45 patients with statin-associated myopathy
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DOI：
10.1001/archinte.165.22.2671
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发表时间：
2005-12-12
影响因子：
--
通讯作者：
Stein, JH
中科院分区：
文献类型：
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作者：
Hansen, KE;Hildebrand, JP;Stein, JH
背景：已发表的有关他汀类药物相关肌病的研究可能描述了更多戏剧性的患者表现，可能导致对病情的不准确描述。此外，他汀类药物相关肌病患者的长期预后和对他汀类药物再挑战的反应在很大程度上是未知的。方法：威斯康星大学医院和诊所医学信息部从超过13年的住院和门诊数据中确定了437名患有国际疾病分类第九次修订代码的患者，这些代码可能代表他汀类药物相关肌病的病例；其中45人被诊断患有他汀类药物相关肌病。使用标准化表格，2名研究人员提取了所有病例记录，以确定他汀类药物诱发的肌病的临床病程。结果：出现症状前他汀类药物治疗的平均（SD）持续时间为6.3（9.8）个月。停止他汀类药物治疗后，肌肉疼痛的缓解平均（SD）为2.3（3.0）个月。6例患者（13%）因横纹肌溶解治疗住院；2例有可逆性肾功能障碍，1例既往存在肾功能不全，随后开始终身透析。住院患者在开始他汀类药物治疗后更快地发生肌病（1.3 vs； 7.1个月；P= 0.048），并且更有可能同时服用已知会增加他汀类药物相关肌病风险的药物（P= 0.03）。37名患者在他汀类药物相关肌病发作后接受了另一种他汀类药物治疗；21例（5.7%）报告复发性肌肉疼痛，而16例（43%）耐受其他他汀类药物而无复发症状。结论：他汀类药物相关肌病患者在停止他汀类药物治疗后肌肉疼痛完全缓解。虽然没有死亡发生，但13%的患者因横纹肌溶解而需要住院治疗。复发性肌肉疼痛在他汀类药物治疗后很常见。
Background: Published studies regarding statin-associated myopathy may describe more dramatic patient presentations, potentially leading to inaccurate characterization of the condition. Furthermore, long-term outcomes and responses to statin rechallenge in patients with statin-associated myopathy are largely unknown.Methods: The University of Wisconsin Hospital and Clinics Medical Informatics Department identified 437 patients with International Classification of Diseases, Ninth Revision codes potentially representing cases of statin-associated myopathy from more than 13 years of inpatient and outpatient data; 45 of these individuals were diagnosed as having statin-associated myopathy. Using a standardized form, 2 researchers abstracted all the case records to define the clinical course of statin-induced myopathy.Results: The mean (SD) duration of statin therapy before symptom onset was 6.3 (9.8) months. Resolution of muscle pain occurred a mean (SD) of 2.3 (3.0) months after discontinuation of statin therapy. Six patients (13%) were hospitalized for the management of rhabdomyolysis; 2 had reversible renal dysfunction, and I with preexisting renal insufficiency subsequently began lifelong dialysis. Hospitalized patients developed myopathy more quickly after initiating statin therapy (1.3 vs; 7.1 months; P=.048) and were more likely to be taking concomitant medications known to increase the risk of statin-associated myopathy (P=.03). Thirty-seven patients received another statin after an episode of statin-associated myopathy; 21 (5 7%) reported recurrent muscle pain, whereas 16 (43%) tolerated other statins without recurrent symptoms.Conclusions: Patients with statin-associated myopathy experienced full resolution of muscle pain on cessation of statin therapy. Although no deaths occurred, 13% of the patients required hospitalization for rhabdomyolysis. Recurrent muscle pain was common on statin rechallenge.