Rosuvastatin-Induced Thrombocytopenic Purpura-A Case Report

Rosuvastatin誘發血小板減少性紫斑症－病例報告

10.29784/DS.200912.0005

林政緯(Zheng-Wei Lin)；何信君(Hsin-Chun Ho)；楊志勛(Chih-Hsun Yang)；許仲瑤(Rosaline Chung-Yee Hui)；鐘文宏(Wen-Hung Chung)

Rosuvastatin ； Idiopathic thrombocytopenic purpura ； Thrombotic thrombocytopenic purpura ； Low-density lipoprotein ； High-density lipoprotein

中華皮膚科醫學雜誌

27卷4期（2009 / 12 / 01）

235 - 240

英文

引起血小板減少性紫斑症的藥物種類繁多，其中包括了降血脂藥。Rosuvastatin為一透過抑制3-hydroxy-3-methylglutaryl-CoA還原的降血脂藥，過去並無文獻報告rosuvastatin引起血小板減少性紫斑症，在此我們提出第一個病例報告。本文報告一位57歲男性，每日服用20毫克rosuvastatin的一個月後，身上出現廣泛性的瘀點與紫斑。當病人停掉此藥且使用為期4週的口服類固醇methylprednisolone後，紫斑完全消失。此紫斑可能由免疫反應所引起。此外，因為statin類的降血脂藥物可以經由抑制活化的血小板血栓PAR-1受體，而具備抗血小板與抗血栓的特性，所以我們推測rosuvastatin可能透過大量抑制血小板血栓受體而產生血小板減少性紫斑症。目前rosuvastatin廣泛地被用來治療高血脂症，而藥物動力學研究結果發現與白種人相較，亞洲人rosuvastatin的血中濃度為其2倍，因此臨床醫師應特別注意亞洲人的起始劑量且需熟悉藥物的副作用。

Many medications can cause thrombocytopenic purpura, including some hypolipidemic agents. This is the first case report of thrombocytopenic purpura due to the 3-hydroxy-3-meth-ylglutaryl-coenzyme A reductase inhibitor, rosuvastatin. A 57-year-old Asian man developed multiple petechiae and purpura one month after receiving rosuvastatin in a dosage of 20 mg/day. When the drug was stopped and the patient was treated with systemic methylprednisolone, 24 mg/day, his symptoms cleared within 4 weeks. The symptoms may have been due to an immune-mediated reaction. Also, since statins can alter antiplatelet and antithrombotic properties through significant inhibition of the activated platelet thrombin receptor (Proteinase-Activated Receptor-1), an overwhelming inhibition of platelet thrombin receptors might also have caused the thrombocytopenia. Because rosuvastatin is used throughout the world to treat hyperlipidemia, and Asian patients have a twofold higher systemic exposure than do Caucasian patients, physicians should be familiar with its possible adverse effects, and use with caution when determining the starting dose, especially among Asian patients.