低分子量肝素与他汀类药物合用致转氨酶升高32例分析  

Analysis for Combined Use of Low Molecular Weight Heparin and Statins Causing Transaminase Elevation in 32 Patients

作　　者：杨旭[1] 黄晓青[1] 张云[1] 孙慧[1] 张海华[1] 张炜[1] 王莉[2] 庞会敏[2] 华潞[2] 李一石[2] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院特需医疗中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管药物临床研究重点实验室,北京市100037

出　　处：《中国循环杂志》2015年第6期567-569,共3页Chinese Circulation Journal

基　　金："重大新药创制"科技重大专项(2012ZX09303-008-001)

摘　　要：目的:分析低分子量肝素与他汀类药物合用致转氨酶升高的临床情况,为临床安全用药提供参考信息。方法:收集2011-01至2012-12本院第11病房合用低分子量肝素和他汀类药物出现丙氨酸氨基转移酶(ALT)水平升高的45例患者数据,剔除既往有转氨酶升高病史、入院即有转氨酶升高、中途中断治疗、肝功能检查资料不全病例,共收集32例,回顾分析低分子量肝素与他汀类药物合用情况、低分子量肝素品种、用药后ALT水平升高出现的时间及临床转归。结果:所有患者均合并使用他汀类药物,包括辛伐他汀、阿托伐他汀、瑞舒伐他汀和普伐他汀,其中15例在使用低分子量肝素前应用他汀类药物,患者所用的低分子量肝素包括依诺肝素、那屈肝素和达肝素钠。32例患者中,ALT水平在正常上限3倍以内者18例,≥正常上限3倍者14例。ALT水平升高出现在低分子量肝素治疗平均第(3.0±3.8)d。所有患者在ALT水平升高后均停用低分子量肝素,16例患者停用他汀类药物。所有患者在应用保肝药物后ALT水平逐渐下降至正常。结论:低分子量肝素与他汀类药物合用可致ALT水平升高,两者可能有协同效应。因此,这两种药物合用时需要加强对肝功能的监测。Objective： To analyze the relevant factors for combined use of low molecular weight heparin （LMWH） and statins causing transaminase elevation and to provide the reference for medication safety in clinical practice. Methods： There were 45 patients who received the combination of LMWH and statins treatment, then having ALT elevation in our ward from 2011-01 to 2012-12 were collected, by exclusion of patients with the history of high ALT at admission, interrupted treatment and incomplete record of liver function tests, a total of 32 patients were ifnally enrolled for investigation. The conditions for using LMWH and statins together, type of LMWH, timing of ALT elevation after medication and clinical outcomes were retrospectively analyzed. Results： All patients received statins including simvastatin, atorvastatin, rosuvastatin and pravastatin, and 15 patients took statins before using LMWH including enoxaparin, nadroparin and dalteparin. There were 18 patients had ALT increased below 3 times of the upper limit and 14 patients had ALT level ≥ 3 times of the upper limit, and ALT elevation occurred at the average of （3 ± 3.8） days after taking LMWH. All patients stopped using LMWH upon ALT elevation and 16 of them stopped taking statins. The ALT level gradually decreased to normal by application of hepatic-protective treatment in all patients.Conclusion： Combined using LMWH and statins could cause ALT elevation, LMWH and statins may have synergistic effect, and therefore, the enhanced monitor of liver function is necessary when using the combined medication.

关 键 词：低分子量肝素 他汀类药物 转氨酶升高 

分 类 号：R54[医药卫生—心血管疾病]