低分子量肝素与他汀类药物合用致转氨酶升高32例分析

发布时间：2018-01-25 14:02

本文关键词： 低分子量肝素他汀类药物转氨酶升高　出处：《中国循环杂志》2015年06期 　论文类型：期刊论文

【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。
[Abstract]:Objective: to analyze the clinical situation of transaminase elevation induced by combination of low molecular weight heparin and statins. Methods: to collect the combination of low molecular weight heparin and statins for alanine aminotransferase (alt) in ward 11 of our hospital from January 2011 to December 2012. Data of 45 patients with elevated levels. Excluding the history of transaminase elevation, there were transaminase elevation on admission, interrupted treatment and incomplete liver function examination. 32 cases were collected and analyzed retrospectively the combination of low molecular weight heparin (LMWH) and statins. Low molecular weight heparin (LMWH), the time and clinical outcome of increased ALT levels after treatment. Results: all patients were treated with statins, including simvastatin and Atto vastatin. Risuvastatin and pravastatin, 15 of which were treated with statins prior to the use of low molecular weight heparin (LMWH), including enoxheparin, nadriparin and dheparin sodium. 32 patients were treated with LMWH. The ALT level was within 3 times of the normal upper limit in 18 cases. The elevation of alt level occurred on the average of 3.0 卤3.8 days after the treatment of low molecular weight heparin. All patients stopped using low molecular weight heparin after the increase of ALT level. The level of ALT gradually decreased to normal in all patients. Conclusion: low molecular weight heparin combined with statins can increase the level of ALT. The two drugs may have synergistic effects. Therefore, the monitoring of liver function needs to be strengthened when the two drugs are combined.
【作者单位】：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;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;
【基金】：“重大新药创制”科技重大专项(2012ZX09303-008-001)
【分类号】：R969.3
【正文快照】： 与普通肝素相比,低分子量肝素具有无可比拟的优势:对凝血因子Xa因子的抑制作用更强;无需严密监测凝血相关指标;血小板减少症发生率低;皮下注射,使用方便,抗凝作用更持久;无需监测活化部分凝血活酶时间(a PTT)等[1]。而他汀类药物凭借其强化降脂、逆转斑块等其他降脂药无可比拟

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