用抗疟药是狼疮肌酶升高危险的因素

摘要
目的:
本研究的目的是分析抗疟药（AM）与系统性红斑狼疮（SLE）肌酶升高之间的关系。

方法：
本研究共纳入325例至少2次连续临床随访时发现肌酸磷酸激酶（CPK）升高的狼疮患者。54例应用他汀/贝特的患者（n=43）和/或活动性肌炎患者（n=14）被除外。对照组为1453例随访期无CPK升高的狼疮患者。统计方法为描述统计与Cox回归分析，p < 0.05认为有统计学意义。

结果：
研究组与对照组在SLE发病年龄、性别比例以及病程上均无差异。研究组中抗疟药的应用更为常见，且抗疟药的应用时间更长。应用抗疟药的患者中出现CPK升高的比例为16.3%（216/1322）。氯喹的应用导致CPK水平升高的风险增加3.3倍，羟氯喹的应用导致CPK水平升高的风险增加3.1倍。黑人种群与高CPK水平相关(HR = 2.941)，女性性别为保护因素(HR = 0.697)。203例患者随访7.3 ± 5.6年，49.8%的患者持续性肌酶升高，14.8%的患者间断肌酶升高，而35.4%的患者肌酶恢复正常。203例患者中有5例出现近端肌无力。

结论：
长期应用抗疟药是SLE患者肌酶升高的潜在危险因素。这些患者中约2/3持续肌酶异常，但长期随访绝大多数病人仍仅表现为实验室检查异常，发展至临床肌病者仅占2.5%。

附原文：
Abstract：OBJECTIVE:To investigate the relationship between antimalarials (AM) and elevated muscle enzymes in systemic lupus erythematosus(SLE).METHODS: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, Urowitz MB. Antimalarials as a risk factor for elevated muscle enzymes in systemic lupus erythematosus. Lupus. 2016 Apr;25(5):532-5.