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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。
OBJECTIVE: To analyze the clinical situation of elevated transaminases combined with low molecular weight heparin and statins to provide reference information for clinical safe medication. Methods: The data of 45 patients with elevated alanine aminotransferase (ALT) in low molecular weight heparin and statins combined in the 11th ward of our hospital from January 2011 to December 2012 were collected. The patients with previous history of elevated aminotransferase, Admission is elevated transaminases, interruption of treatment, incomplete liver function test cases, a total of 32 cases were collected, retrospective analysis of low molecular weight heparin and statins combined with low molecular weight heparin varieties, after treatment ALT levels rise time and Clinical outcome. RESULTS: All patients underwent statin use, including simvastatin, atorvastatin, rosuvastatin and pravastatin. Fifteen of these patients received statins before low-molecular-weight heparin and low-weight heparin Including enoxaparin, nadroparin and dalteparin sodium. 32 patients, ALT levels in the upper limit of normal within 3 times in 18 cases, ≥ 3 times the upper limit of normal in 14 cases. Elevated ALT appeared in the low-molecular-weight heparin treatment average (3.0 ± 3.8) d. All patients discontinued low-molecular-weight heparin after ALT levels were elevated, and statins were discontinued in 16 patients. ALT levels gradually decreased to normal in all patients after application of hepatoprotective drugs. Conclusion: The combination of low molecular weight heparin and statins can cause elevated ALT levels, the two may have a synergistic effect. Therefore, the combination of these two drugs need to strengthen the monitoring of liver function.