目的：研究狼瘡患者中應用抗瘧藥與肌酶升高的關係。
方法：共納入325例至少在連續兩次門診隨訪中都有肌酶升高的狼瘡患者，其中排除54例服用他汀藥的患者和14例合並活動性肌炎的患者。對照組為1453例無肌酶升高的狼瘡患者。應用描述性統計分析及Cox回歸方法分析資料。
結果：兩組之間基線資料匹配。病例組抗瘧藥的應用更多，應用時間更長。應用抗瘧藥的患者中肌酶升高的比例為216/1322（16.3%），氯喹和羥氯喹導致肌酶升高的風險分別是3.3倍和3.1倍。非洲裔人種肌酶升高風險更大，而女性為保護因素。203例患者共隨訪7.3 ± 5.6年，49.8%的患者肌酶持續升高，14.8%間斷升高，而35.4%肌酶逐漸正常。5例患者出現有臨床症狀的近端肌無力。
結論：長期應用抗瘧藥可能是狼瘡患者肌酶升高的危險因素。在2/3的患者中肌酶持續升高，但多數僅僅是一種生化檢查異常，其中2.5%發展為有臨床症狀的肌病。
附原文：
OBJECTIVE:To investigate the relationship between antimalarials (AM) and elevated muscle enzymes in systemic lupus erythematosus (SLE).PATIENTSMETHODS: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, et al. Antimalarials as a risk factor for elevated muscle enzymes in systemic lupus erythematosus. Lupus, 2015,12(3):345-67
