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1例88岁男性患者,因急性冠脉综合征联合使用氯吡格雷、阿司匹林、酒石酸美托洛尔、替米沙坦、辛伐他汀、达肝素钠、硝酸甘油。第5天辛伐他汀剂量由20 mg,每晚1次增至40 mg,每晚1次。第8天停用替米沙坦,给予口服地尔硫15 mg,3次/d和苯磺酸氨氯地平。第42天患者出现骨骼肌极度乏力伴肌痛。实验室检查:肌酸激酶(CK)8100 U/L,肌酸激酶同工酶305 U/L,肌钙蛋白0.046μg/L,丙氨酸转氨酶(ALT)102 U/L,天冬氨酸转氨酶(AST)151 U/L。停用辛伐他汀并静脉滴注硫普罗宁。停药第16天复查血生化:CK 55 U/L,ALT 13 U/L,AST 14 U/L。8天后再次联合应用辛伐他汀10 mg,每晚1次与地尔硫30 mg,3次/d,应用22天未见CK和肝功能异常。
One 88-year-old man with clopidogrel, aspirin, metoprolol tartrate, telmisartan, simvastatin, dalteparin and nitroglycerin was used for acute coronary syndromes. On day 5, the dose of simvastatin increased from 20 mg to 40 mg once nightly, once night. Telmisartan was discontinued on day 8, and oral diltiazem 15 mg, 3 times daily and amlodipine besylate were administered. Day 42 Patients with skeletal muscle weakness with myalgia. Laboratory tests: creatine kinase (CK) 8100 U / L, creatine kinase isoenzyme 305 U / L, troponin 0.046 μg / L, alanine aminotransferase (ALT) 102 U / L, aspartic acid Aminotransferase (AST) 151 U / L. Stop simvastatin and intravenous tiopronin. On the 16th day of withdrawal, blood biochemistry was reviewed: CK 55 U / L, ALT 13 U / L and AST 14 U / L. After 8 days, simvastatin 10 mg was once again combined with diltiazem 30 mg three times a day for three days. No CK and liver dysfunction were found after 22 days of application.