秋水仙碱致慢性肾脏病患者肌肉病变1例  

A case report of colchicine-induced myopathy in a patient with chronic kidney disease

作　　者：杜莹珏[1] 刘维超 陈茜 程永静[1] DU Ying-jue;LIU Wei-chao;CHEN Xi;CHENG Yong-jing(Department of Rheumatology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Rheumatology,Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650500,China;National Cancer Center,National Clinical Research Center for Cancer,Department of Medical Oncology,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]北京医院风湿免疫科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]云南中医药大学第一附属医院风湿科,昆明650021 [3]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院内科,北京100021

出　　处：《北京大学学报（医学版）》2021年第6期1188-1190,共3页Journal of Peking University:Health Sciences

基　　金：云南省高层次中医药后备人才培养项目[云财社(2021)56号]。

摘　　要：1病例资料,患者,男性,51岁,因“反复关节肿痛10年,加重伴双下肢肌痛20天”入院。患者10年前于高嘌呤饮食后出现左第一跖趾关节红、肿、热、痛症状,应用双氯芬酸后好转。近7年来反复出现关节肿痛症状,多于高嘌呤饮食后出现,先后累及双侧第一跖趾、踝、膝、腕等关节,发作时自服秋水仙碱1~2 mg/d或双氯芬酸25 mg/d,约3~5 d后症状可逐渐缓解,曾查血尿酸(uric acid,UA)>600μmol/L,但未服用降尿酸药物。Colchicine plays an important role in the treatment of gout and some other diseases.Besides gastrointestinal symptoms,myopathy has been reported as a rare side effect of colchicine in some patients.We report a case of myopathy in a patient with chronic kidney disease caused by high-dose colchicine,and then review literature on colchicine-induced myopathy,so as to provide some experience for the clinical diagnosis,treatment and medication safety.A 51-year-old male patient with 10 years of gout and 5 years of chronic kidney disease history and irregular treatment was admitted to the hospital with complaint of recurrent left wrist arthralgia and emerging lower extremities myalgia after intake of 40-50 mg colchicine in total within 20 days.Laboratory examinations showed significantly increased creatine kinase(CK)and then colchicine-induced myopathy was diagnosed preliminarily.After withdrawl of colchicine and implementation of hydration,alkalization and intramuscular injection of compound betamethasone,the symptoms of arthralgia and myalgia were relieved within 3 days and CK decreased to normal range gradually.According to literature reports,colchicine related myopathy was mostly characterized by proximal myasthenia and myalgia,accompanied by elevated CK level,which usually occurred days to weeks after initial administration of colchicine at the usual dosage in patients with renal impairment or a change in the underlying disease state in those receiving long-term therapy,and the features might remit within three to four weeks after the drug was discontinued.Electromyography of proximal muscles showed myopathy marked by abnormal spontaneous activity and muscle pathology waa marked by accumulation of lysosomes and autophagic vacuoles.Chronic kidney disease,liver cirrhosis,higher colchicine dose and concomitant cytochrome P4503A4(CYP3A4)inhibitors were associated with increased risk of myo-pathy.Based on the similar efficacy and lower adverse reaction rate compared with larger dosage,small dose of colchicine was recomme

关 键 词：秋水仙碱 肌病 不良反应 

分 类 号：R593.22[医药卫生—内科学]