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药物诱导性肌病

Author
Marc L Miller, MD
Section Editors
Ira N Targoff, MD
Jeremy M Shefner, MD, PhD
Deputy Editor
Monica Ramirez Curtis, MD, MPH

引言

虽然准确的发病率未知，但是药物诱导性肌病是肌肉疾病中最常见的原因之一。药物诱导性肌病轻则为伴或不伴轻度肌无力的轻度肌痛，重则为伴重度肌无力的慢性肌病，以及伴急性肾衰竭的大量横纹肌溶解[1,2]。有150多种药物都与横纹肌溶解有关[3]。本专题将总结药物诱导性肌病。横纹肌溶解和他汀类药物相关性肌病将会单独详细讨论。 (参见“横纹肌溶解症的病因”和“横纹肌溶解的临床表现与诊断”和“他汀类药物相关性肌病”)

发病机制

药物诱导性肌病可能有多种发病机制，包括[4,5]：

●直接肌毒性–例如酒精、可卡因、糖皮质激素类、降脂药、抗疟药(与空泡性肌病相关)、秋水仙碱(也与空泡性肌病相关)及齐多夫定(导致线粒体肌病)。

●免疫诱导的炎性肌病–比如与D-青霉胺相关的肌病。

●间接性肌损伤–可导致这个问题的机制很多，包括药物引起的昏迷伴随后的肌肉压迫性缺血、药物引起的低钾血症(如利尿剂)、药物引起的高动力状态(如酒精引起的震颤性谵妄或抽搐)、吩噻嗪类引起的肌张力障碍状态、与可卡因使用有关的过热，以及抗精神病药恶性综合征。

                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-03.
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