a:甲减患者常易合并血脂异常、特别是高胆固醇血症;甲减患者继发高胆固醇血症应用他汀治疗,发生肌损害的风险会明显高于其他患者,故对于这类患者,首选药物不是他汀,而是左甲状腺素片,给予左甲状腺素治疗,可在一定程度上调节血脂,部分患者甚至不使用降脂药即可恢复正常。 b:甲减患者可增加发生肌病的风险;对于伴有 CK 升高的继发高胆固醇血症甲减患者,应慎重使用他汀类药物;CK 极度升高的甲减患者,应避免剧烈运动和使用他汀类药物,以减少发生横纹肌溶解的风险; c:已使用他汀类降脂药物的甲减患者应做好自我监测,注意戒烟戒酒、不摄入葡萄柚汁等,定期检查 CK 水平,如果出现肌痛、肌肉无力等症状,应及时就医;服用他汀类药物,导致肌酶升高的甲减患者,及时停药后肌酶能够恢复至正常水平。
本文作者:刘洁,缪洪芸,王雪
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