目的 探讨甲状腺功能减退患者应用非诺贝特发生横纹肌溶解的临床特征,为临床安全用药提供参考。方法 分享1例甲状腺功能减退患者应用非诺贝特发生横纹肌溶解的临床案例,检索国内外报道的不良反应文献,归纳总结其发生特点。结果 25岁女性,高脂血症合并甲状腺功能减退,应用非诺贝特12 d后发生横纹肌溶解症,横纹肌溶解发生前监测甲功TSH高,不良反应发生后停用非诺贝特并积极补液同时碱化尿液,症状好转出院。文献检索到11例甲减患者应用非诺贝特发生横纹肌溶解的报道,年龄25~68岁,男女比例1∶2,除3例甲状腺功能不详外,6例为甲状腺功能减退,2例游离甲状腺素(FT4)在正常低限。9例非诺贝特剂量符合说明书,3例剂量超过说明书推荐剂量。药物不良反应(adverse drug reaction,ADR)多发生于用药后3~60 d。10例痊愈,2例好转。结论 甲状腺功能减退可能是非诺贝特发生横纹肌溶解的风险因素,甲状腺功能减退患者用药前应监测甲状腺功能,并调整治疗使FT4和TSH控制在正常范围。
Abstract
OBJECTIVE To explore clinical characteristics of rhabdomyolysis caused by fenofibrate in patients with hypothyroidism. METHODS A clinical case was analyzed and summarized the literature of adverse reactions of rhabdomyolysis caused by fenofibrate in patients with hypothyroidism reported in China and abroad. RESULTS A 25-year-old female with hyperlipidemia combined with hypothyroidism developed rhabdomyolysis at 12th day after taking fenofibrate. Before the occurrence of rhabdomyolysis, highlevelof TSH was detected. After occurrence of adverse reactions, the patient stopped taking fenofibrate, rehydrated and alkalized urine. Then the patient recovered and discharged. In the literature review, 11 cases of rhabdomyolysis with fenofibrate in hypothyroidism were included. The age range was 25-68. The sex ratio was 1∶2. On thyroid function, there were 3 cases unknown, 6 cases with hypothyroidism and 2 cases with FT4 at the lowest normal limit. On doses of fenofibrate, there were 9 cases under the instructions, and 3 cases beyond the recommendations in labeling. Most adverse drug reactions (ADRs) occurred at the third to 60th day after taking fenofibrate. Ten patients recovered and 2 patients improved. CONCLUSION Hypothyroidism would be a risk factor for rhabdomyolysis caused by fenofibrate. Thyroid function should be monitored in patients taking fenofibrate with hypothyroidism.
关键词
非诺贝特 /
甲状腺功能减退 /
横纹肌溶解
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Key words
fenofibrate /
hypothyroidism /
rhabdomyolysis
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中图分类号：
R95
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参考文献
[1] YANG C Y, HE G. Fenofibrate-associated rhabdomyolysis in a hypothyroidism patient: a case. Chin J Drug Appl Monitor(中国药物应用与监测), 2010, 7(6): 383-384.
[2] FENG X M, XU Y.A case of fenofibrate-related rhabdomyolysisin a patient of anterior pituitary hypofunction. Chin General Pract(中国全科医学), 2010, 13(8): 904-905.
[3] WANG C, AI D Y. A case of fenofibrate-related rhabdomyolysis. Her Med(医药导报), 2004(2): 126.
[4] YU H M, JIAO F L. A case of fenofibrate-related rhabdomyolysis. J Hubei Univ Med(湖北医学院学报), 2017, 36(2): 170-171.
[5] LU Q. Fenofibrate-associated rhabdomyolysis and liver injury. Chin J Pharmacoepidemiol(药物流行病学杂志), 2010, 19(5): 284.
[6] ZHANG W L. A case of fenofibrate-related rhabdomyolysis. Med J Nat Defend Forces North China(华北国防医药), 2009, 21(5): 33.
[7] ZHANG J Y, WEI J P. A case of overdose fenofibrate-inducedrhabdomyolysis. J Pract Med(实用医学杂志), 2012, 28(19): 3317.
[8] ZHANG M, LIU S L, WU N Q, et al. Combination of simvastatin and fenofibrate induced drug-associated myopathyinhypothyroidism patient: a case report. Chin Circul J(中国循环杂志), 2017, 32(9): 849.
[9] LI D. A case report of fenofibrate-associated acute rhabdomyolysis. Chin J Integr Tradit West Med Intensive Crit Care(中国中西医结合急救杂志), 2013(4): 255.
WANG D, WANG Y. Fenofibrate monotherapy-induced rhabdomyolysis in a patient with hypothyroidism: a rare case report and literature review. Medicine (Baltimore), 2018, 97(14): e318-320.
SOUSA A A, KRONIT H S, NEVES F A, et al. Fenofibrate-induced rhabdomyolysis in a patient with chronic kidney disease: an unusual presenting feature of hypothyroidism. Arq Bras Endocrinol Metabol, 2009, 53(3): 383-386.
ADKINS J C, FAULDS D. Micronised fenofibrate: a review of its pharmacodynamic properties and clinical efficacy in the management of dyslipidaemia. Drugs, 1997, 54(4): 615-633.
Joint committee of prophylaxis and treatment of dyslipidemia in Chinese Adults Prophylaxis and treatment Guideline of dyslipidemiain Chinese Adults(2016 revised Edition) . Chin J Health Manage(中华健康管理学杂志), 2017, 11(1): 7-28.
HEKIMSOY Z, OKTE M I K. Serum creatine kinase levels in overt and subclinical hypothyroidism. Endocr Res, 2005, 31(3): 171-175.
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