循证证据比较他汀类药物的获益与肌病相关风险的新进展

发布时间：2018-04-14 06:21

本文选题：他汀 + 获益　；参考：《中国药学杂志》2015年17期

【摘要】：以指南和循证医学证据为基础,对他汀类药物的获益与肌病、横纹肌溶解等风险进行综述。提出他汀类药物的化学结构特征与类效应、异质性密切相关。明确了高强度应用他汀(阿托伐他汀、瑞舒伐他汀)用于动脉粥样硬化心血管疾病的一级和二级预防可给患者带来更多临床获益。尽管瑞舒伐他汀在同类药物中药理作用较强,但是由于磺酰胺基团的存在导致其毒性增大,国外循证证据表明,瑞舒伐他汀的横纹肌溶解风险明显高于阿托伐他汀等其他他汀类药物。因此,对于存在危险因素的患者选择瑞舒伐他汀治疗时需谨慎用药,权衡效益风险比。近来瑞舒伐他汀导致肌病、横纹肌溶解的病例在全球有增多的趋势,应引起临床的高度关注。临床药师应从特殊病理生理状态、相互作用、药物基因组学等方面着手,总结分析其发生规律、研究其发病机制以保障患者的用药安全,以承担起临床药师义不容辞的责任。
[Abstract]:Based on guidelines and evidence-based medical evidence, the benefits of statins and risks of myopathy and rhabdomyolysis are reviewed.It is suggested that the chemical structure of statins is closely related to the class effect and heterogeneity.It is clear that the primary and secondary prophylaxis of high intensity statins (Atto vastatin, resuvastatin) for atherosclerotic cardiovascular disease can bring more clinical benefits to patients.Although rosuvastatin has a strong pharmacological effect in the same class of drugs, its toxicity is increased due to the presence of sulfonamide groups.The rhabdomyolysis risk of recuvastatin was significantly higher than that of other statins such as Atto vastatin.Therefore, for patients with risk factors, it is necessary to weigh the benefit-risk ratio when choosing Risuvastatin.Recently-reported cases of rhabdomyolysis due to myopathy caused by recuvastatin are increasing globally and should be of great clinical concern.Clinical pharmacists should start from the aspects of special pathophysiology, interaction, pharmacogenomics, summarize and analyze its occurrence law, study its pathogenesis in order to ensure the safety of drug use of patients, so as to assume the unshirkable responsibility of clinical pharmacists.
【作者单位】：解放军第八一医院药学科;海军总医院;
【分类号】：R972;R-03

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