他汀类药物的肾脏安全性及在慢性肾脏病患者中的应用  

Review safety of statins and its application in the patients with chronic kidney disease

作　　者：闫婷婷[1] 刘维[1] 杨丽[1] 陈恳[1] 翟所迪[1] 

机构地区：[1]北京大学第三医院药剂科/北京大学治疗药物监测与临床毒理中心,100191

出　　处：《药物不良反应杂志》2016年第5期356-359,共4页Adverse Drug Reactions Journal

摘　　要：他汀类药物（他汀）作为有效的降脂药在预防心脑血管疾病方面起着不可或缺的作用。他汀可增加急性肾损伤的发生风险，并且呈明显的剂量相关性。他汀相关的急性肾损伤与横纹肌溶解导致的急性肾小管坏死有关。他汀可导致蛋白尿或血肌酐水平升高，多较为短暂，呈一过性。他汀相关的蛋白尿为肾小管对蛋白质的重吸收障碍所致。不同他汀的肾脏安全性不同，瑞舒伐他汀和辛伐他汀引起肾脏不良反应的风险高于其他他汀，阿托伐他汀和氟伐他汀肾脏排泄很少，安全性较高。慢性肾脏病患者应用他汀是安全的，可降低其心脑血管事件的发生风险，但是在启动他汀治疗前应进行风险与获益评价，合理选择药物并注意调整剂量。statins play an important role in prevention of cardiovascular and cerebrovascular diseases for their excellent lipid-lowing efficacy. However,statins can increase the risk of the occurrence of acute kidney injury（ AKI）with significant dose correlation. statins related AKI is associated with acute tubular necrosis when rhabdomyolysis occurred. statins can lead to proteinuria or elevated serum creatinine levels, most of the changes are transient. statins related proteinuria is caused by protein malabsorption in renal tubules. Renal safety of statins is different,rosuvastatin and simvastatin are more likely to cause renal adverse reactions. Atorvastatin and fluvastatin are safer to kidney with little renal excretion. Patients with chronic kidney disease are safe to use statins since they could reduce the risk of cardiovascular events. However before statins therapy starts,risk and benefit evaluation should be carried out,and attentions should be paid to drug selection and dose adjustment.

关 键 词：急性肾损伤 病人安全 他汀类 

分 类 号：R692[医药卫生—泌尿科学]