使用他汀类药物导致肾移植受者横纹肌溶解症二例  

Statin-induced rhabdomyolysis in renal transplant recipients： two cases reports

作　　者：刘光军[1] 吴建永[1] 王逸民[1] 黄洪锋[1] 彭文翰[1] 张建国[1] 陈江华[1] 

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心,杭州310003

出　　处：《中华器官移植杂志》2017年第1期15-17,共3页Chinese Journal of Organ Transplantation

摘　　要：目的 探讨他汀类药物导致肾移植受者横纹肌溶解的病因机制.方法 回顾分析2012年2例肾移植受者发生横纹肌溶解的临床资料和实验室检查结果,以及诊治方法.结果 2例受者均为肾移植后采用以环孢素A为基础的药物预防排斥反应,在增加使用辛伐他汀后出现横纹肌溶解症,且1例合并急性肾功能衰竭,经移植肾活检明确为肾小管上皮损伤.在停用他汀类药物,给予大量补液、利尿、碱化尿液,急性肾功能衰竭受者行血浆置换和持续床边超滤,2例患者症状完全缓解,肌酸激酶降至正常,肾功能衰竭的受者肾功能恢复至基础水平.肾移植受者,特别是采用以环孢素A为基础预防排斥反应药的受者,因治疗高脂血症需使用他汀类药物的同时,需监测环孢素A药物浓度,同时需密切关注可能导致的肌肉毒性,尽量避免合并使用经P450 3A4代谢的药物.结论 治疗高脂血症的受者时应避免联合使用通过P450 CYP3A4代谢的降脂药和环孢素A,若要使用,应从小剂量开始,同时监测肌酸激酶.Objective To discuss the pathogenesis of the statin-induced rhabdomyolysis in renal transplant recipients.Methods We presented two renal transplant recipients who developed rhabdomyolysis in 2012 in our hospital.The clinical presentation,laboratory results,diagnosis and treatment of the two patients were analyzed retrospectively.The basic immunosuppressive agent of two patients was cyclosporine A.The recipients developed rhabdomyolysis following simvastatin lipidlowering therapy,and one patient suffered acute renal failure simultaneously.Acute tubular injury was confirmed by renal biopsy.Finally,the symptoms of the two patients were relieved completely,creatine kinase （CK） returned to normal after the satins discontinued and saline,sodium bicarbonate and diuretics were given.The renal failure patient underwent plasma exchange and CRRT,and the renal function returned to normal.Results The level of cyclosporine A should be monitored when the renal transplant patient was given statins,especially whose basic immunosuppressive agent was cyclosporine A.At the same time we should pay more attention to the symptoms of the myotoxic side effects and avoid using the drug which was also metabolized by CYP3A4.Conclusion Physicians should be aware of the potential risks of combined therapy of statins which are metabolized by P450CYP3A4 and cyclosporine A in transplant patients.If using it is advisable to begin with small dosage and monitor the CK level.

关 键 词：肾移植 他汀类药物 横纹肌溶解症 急性肾功能衰竭 

分 类 号：R699.2[医药卫生—泌尿科学]