摘要
1例51岁男性患者因高脂血症、慢性肾脏病尿毒症期、尿毒症性心肌病、高血压病、骨质疏松症及2型糖尿病，口服阿托伐他汀钙（20 mg/d）、奥美沙坦（20 mg/d）、硝苯地平（30 mg/d）、单硝酸异山梨酯（40 mg/d）、骨化三醇（0.5 μg/d）和醋酸钙（0.6 g/d），皮下注射胰岛素，并行维持性腹膜透析。因实验室检查示血清总胆固醇 7.0 mmol/L、三酰甘油 9.9 mmol/L，停用阿托伐他汀钙，改为苯扎贝特0.2 g，3次/d口服。换药第4天，患者诉全身疼痛；第6天，患者出现焦虑、烦躁，且腹膜透析流出液颜色加深；第7天，患者外周血白细胞计数（WBC）33.0×10^9/L，中性粒细胞0. 95，肌酸激酶〉10 000 U/L，肌红蛋白 2 876 μg/L，丙氨酸转氨酶（ALT）460 U/L，尿素 20.9 mmol/L，肌酐1 294 μmol/L。考虑为苯扎贝特引起的横纹肌溶解症。当日停用苯扎贝特，给予保护肝肾功能、营养心肌及连续性静脉-静脉血液透析滤过等对症处理，其他药物继续服用。停药第7天，患者精神症状好转，未再诉疼痛；第16天，WBC 16.0×10^9/L，中性粒细胞0.81，肌酸激酶154 U/L，肌红蛋白288 μg/L，ALT 21 U/L，尿素12.0 mmol/L，肌酐564 μmol/L。随访至停药60 d，患者未再诉全身疼痛，未再出现焦虑、烦躁等精神症状。
A 51-year-old male patient with hyperlipidemia, uremia, uremic cardiomyopathy, hypertension, osteoporosis and type 2 diabetes received atorvastatin calcium 20 mg/d, olmesartan 20 mg/d, nifedipine 30 mg/d, isosorbide 5-mononitrate 40 mg/d, calcitriol 0.5 μg/d, calcium acetate 0.6 g/d. In addition, the patient received hypodermic injection of insulin according to blood sugar level, and maintained peritoneal dialysis. The patient stopped using atorvastatin and switched to bezafibrate dispersible tablets 0.2 g three time daily because of his high levels of total cholesterol （7.0 mmol/L） and triacylglycerol （9.9 mmol/L） . On day 4 of changing the prescription, the patient complained of whole body pain. On day 6 of changing the prescription, the patient became anxious, irritable, and had darkened peritoneal dialysis fluid. Laboratory test showed the following values： white blood cell count （WBC） 33.0×10^9/L, neutrophil 0.95, creatine kinase （CK） 〉10 000 U/L, myoglobin 2 876 μg/L, alanine aminotransferase （ALT） 460 U/L, urea 20.9 mmol/L, and creatinine （Cr） 1 294 μmol/L on day 7 of changing medical prescription. The patient was diagnosed as rhabdomyolysis due to bezafibrate. Bezafibrate was withdrawn on the same day. He received the symptomatic treatments including liver and kidney protection, nourishing myocardium, and vein-vein hemodialysis besides continuing to take the other drugs mentioned above. On day 7 of stopping bezafibrate the patient＇s mental symptoms improved. Laboratory test showed the following values： WBC 16.0×10^9/L, neutrophil 0.81, CK 154 U/L, myoglobin 288 μg/L, ALT 21 U/L, urea 12.0 mmol/L, and Cr 564 μmol/L on day 16 of stopping bezafibrate.The patient did not complain of pain, the symptoms of anxiety and irritability did not appear until the day 60 of drug withdrawal.
出处
《药物不良反应杂志》
CSCD
2015年第5期393-394,共2页
Adverse Drug Reactions Journal
