[摘要] 1例50岁女性患者，因肾功能不全并肺部感染给予莫西沙星氯化钠注射液（0.4 g，ivgtt，qd）抗感染治疗，用药3 d后，患者出现　骨骼肌横纹肌溶解症状和体征，如胸闷、心慌，双下肢肌力2级等，全血肌红蛋白> 500 ng·mL -1。停用莫西沙星，给予注射用还原型谷胱甘肽、硝酸甘油片等对症治疗，同时继续给予床旁血液透析治疗。10 d后，患者横纹肌溶解症状和体征逐渐缓解，胸闷、心慌好转，双下肢肌力5级等，全血肌红蛋白110 ng·mL -1。莫西沙星致横纹肌溶解的发病　机制可能与其特有化学结构致细胞内ATP水平下降和肌质网内Ca 2+水平升高有关。

[文献标识码] B

[文章编号] 1672–8157(2015)05–0323–03

[通信作者] 李忠东，男，教授，主要从事临床药学与临床药理学研究。E-mail：zhdl009@126.com

[作者简介] 张华，女，副主任药师，主要从事临床药学与药房管理工作。E-mail：66928776@163.com

One case of rhabdomyolysis induced by moxifl oxacin and literature review

ZHANG Hua, LIU Min, LI Zhong-dong

(Department of Pharmacy, General Hospital of Air Force, Beijing　100142, China)

[ABSTRACT] One 50-year-old female patient with renal inadequacy was given moxifl oxacin (0.4 g, ivgtt, qd) for pulmonary infection. After 3 days, the patient developed suspectable rhabdomyolysis manifesting as dyspnea, palpitations, class 2 myodynamia in both lower extremities and whole blood myohemoglobin > 500 ng·mL -1. Moxifloxacin was stopped immediately and reduced glutathione for injection, nitroglycerin tablets were given to her. Haemodialysis at bedside continued. After 10 days, dyspnea and palpitations improved. Myodynamia in both lower extremities improved from class 2 to class 5, and the whole blood myohemoglobin decreased to 110 ng·mL -1. The pathogenesis of moxifl oxacin-induced rhabdomyolysis may be related to the decrease of cellular ATP and the increase of sarcoplasmic reticulum Ca 2+level induced by its specifi c chemical structure.

[KEY　WORDS] Moxifl oxacin; Rhabdomyolysis; Myohemoglobin; Creatine kinase

1　临床资料

患者，女性，50岁，因“血液透析治疗2年余，反复咳嗽、咳痰伴胸闷，加重1周”于2013年1月5日入院。入院后诊断为：1）慢性肾功　能不全尿毒症期；　2）肺部感染；3）肾性贫血；4）营养不良性贫血；5）心功能不全；6）乳腺癌术后；7）结肠癌术后；8）冠状动脉粥样硬化性心脏病。1月5日生化全套结果示：血钠131 mmol·L -1，丙氨酸氨基转移酶41 IU·L -1，天门冬氨酸氨基转移酶167 IU·L -1，乳酸脱氢酶578 IU·L -1，γ-谷氨酰转肽酶123 IU·L -1，α-羟丁酸脱氢酶356 IU·L -1，均轻度升高；血常规示：WBC 11.9×10 9·L -1，嗜中性粒细胞百分比89.8%。予以莫西沙星氯化钠注射液（拜耳医药保健有限公司，规格：0.4 g，批号BJ07296）0.4 g，ivgtt，qd抗感染；促红细胞生成素3000 IU，im，每周3次，纠正肾性贫血；左卡尼汀注射液+ 0.9%氯化钠注射液100 mL，ivgtt，qd，提供心肌能量；单硝酸异山梨酯缓释片（60 mg，qd）改善心肌供血；血液透析纠正尿毒症等对症治疗。1月……