狼疮患者服用抗疟药可导致肌酶升高

作者：Tselios K，et al. 翻译：北医三院邓晓莉（m13683657545@163.com） 发布：孙琳 审核：姚中强

目的：研究狼疮患者中应用抗疟药与肌酶升高的关系。
方法：共纳入325例至少在连续两次门诊随访中都有肌酶升高的狼疮患者，其中排除54例服用他汀药的患者和14例合并活动性肌炎的患者。对照组为1453例无肌酶升高的狼疮患者。应用描述性统计分析及Cox回归方法分析资料。
结果：两组之间基线资料匹配。病例组抗疟药的应用更多，应用时间更长。应用抗疟药的患者中肌酶升高的比例为216/1322（16.3%），氯喹和羟氯喹导致肌酶升高的风险分别是3.3倍和3.1倍。非洲裔人种肌酶升高风险更大，而女性为保护因素。203例患者共随访7.3 ± 5.6年，49.8%的患者肌酶持续升高，14.8%间断升高，而35.4%肌酶逐渐正常。5例患者出现有临床症状的近端肌无力。
结论：长期应用抗疟药可能是狼疮患者肌酶升高的危险因素。在2/3的患者中肌酶持续升高，但多数仅仅是一种生化检查异常，其中2.5%发展为有临床症状的肌病。


附原文：OBJECTIVE: To investigate the relationship between antimalarials (AM) and elevated muscle enzymes in systemic lupus erythematosus (SLE). PATIENTSMETHODS: 325 lupus patients with abnormal creatine phosphokinase (CPK) for at least two consecutive clinic visits were enrolled; 54 patients on statins/fibrates (n = 43) and/or active myositis (n = 14) were excluded. The control group consisted of 1453 lupus patients with no CPK elevation during follow-up. Descriptive statistics and Cox regression analyses were performed, p < 0.05 was considered significant. RESULTS: Cases and controls did not differ regarding age at SLE diagnosis, gender ratio, or disease duration. AM use was more frequent in cases, which had more prolonged AM use. Total frequency of elevated CPK in AM users was 216/1322 (16.3%). Chloroquine was associated with a 3.3-fold, and hydroxychloroquine with a 3.1-fold, increased risk for CPK elevation. Black race was associated with higher CPK (HR = 2.941), whereas female gender was protective (HR = 0.697). 203 patients were followed for 7.3 ± 5.6 years; 49.8% had persistent and 14.8% intermittent CPK elevation, while in 35.4% CPK was normalized. Clinical proximal muscle weakness developed in 5/203 patients. CONCLUSIONS: Chronic AM use is a potential risk factor for muscle enzyme elevation in SLE patients. CPK abnormalities persist in almost two thirds of the patients, but this remains mainly a biochemical finding, evolving to clinical myopathy in about 2.5%.
引自：Tselios K, Gladman DD, Su J, et al. Antimalarials as a risk factor for elevated muscle enzymes in systemic lupus erythematosus. Lupus, 2015,12(3):345-67

译者介绍：邓晓莉

邓晓莉，女，医学博士，副教授，北京大学第三医院风湿免疫科副主任医师。北京医学会风湿病学分第四届委员会第二届中青年委员会委员。2005年毕业于北京大学医学部临床医学系。毕业后一直在北京大学第三医院工作至今。 2012年赴美学习一年。主要研究系统性红斑狼疮、抗磷脂综合征、血管炎、白塞病等多种风湿免疫病的诊断和治疗。目前主要负责免疫吸附对重症狼疮的治疗研究、狼疮心血管并发症的相关研究，并参与国家11.5重点支撑项目“系统性红斑狼疮的诊断、治疗综合研究”、狼疮肾炎的强化治疗以及巨细胞病毒与狼疮发病的相关性研究。发表国内学术文章数十篇，其中SCI检索文章数篇。参与编写和翻译了《图表式临床风湿病学》、《类风湿关节炎》和《关节炎诊断与治疗》。