张国领

[摘要] 1例高脂血症患者服用辛伐他汀治疗，连续用药12 d后出现双侧踝关节水肿疼痛症状并逐渐加重，至第21天起停止治疗，停药第4天起踝关节肿痛症状逐渐减轻，停药第16天起症状完全消失，随访观察60 d症状未再出现。结合病史、临床表现、鉴别诊断、实验室及影像学检查，最后确诊为辛伐他汀不良反应性双侧踝关节水肿。通过对病例的回顾总结提示，辛伐他汀广泛应用于高脂血症、冠心病、高血压病、糖尿病、代谢综合征、慢性肾脏病、缺血性脑血管病等患者的临床治疗，疗效确切，但其不良反应屡见报道，甚至有严重的病例，不容忽视。为了确保用药安全，在使用辛伐他汀时，应做好不良反应的监测和及时有效治疗处理。

[关键词] 辛伐他汀；高脂血症；药物不良反应；病例报告

[中图分类号] R587；R972 [文献标识码] A [文章编号] 1673-7210（2017）01（c）-0177-03

[Abstract] One patient with hyperlipidemia took Simvastatin for treatment， after continuous medication for 12 days， the patient′s bilateral ankle edema had the pain symptoms and gradually enhances， when it came to the 21st day， the treatment stopped， after 4 days without medicine the patient gradually relieved from the ankle joint pain symptoms， after 16 days the symptoms completely disappeared， followed up for 60 days the symptoms didn′t occur. Combined with medical history， clinical manifestations， differential diagnosis， laboratory and imaging examination， the final diagnosis was the treatment of Simvastatin induced bilateral ankle edema. By reviewing and summarizing of cases， Simvastatin is widely used in hyperlipidemia， coronary heart disease， hypertension， diabetes， metabolic syndrome， chronic kidney disease and ischemic cerebrovascular disease in patients with clinical treatment， curative effect， but its adverse reactions have been frequently reported， even in severe cases， which could not be ignored. In order to ensure the safety of medication， in the use of Simvastatin， adverse reactions should be monitored and timely treated effectively.

[Key words] Simvastatin； Hyperlipidemia； Adverse drug reaction； Case report

辛伐他汀是他汀類调脂药物，作为一线用药，广泛应用于高脂血症的降脂治疗[1-3]，预防和治疗冠心病及其并发症如不稳定性心绞痛、急性心肌梗死、心源性猝死等[4-8]，也常用于高血压、糖尿病、代谢综合征、慢性肾脏病、缺血性脑血管病等特殊人群合并高脂血症的临床治疗[9-12]，其疗效得到充分肯定，但不良反应也有不少报道，不良反应的临床表现多种多样，多见或罕见，有的病例甚至后果严重，为了确保用药安全，值得高度重视。

本文选自解放军第三〇九医院门诊病例，1例高脂血症患者服用辛伐他汀治疗后发生极少见的双侧踝关节水……