跟腱病的药物相关性危险因素的研究进展

Advances in the Study of Drug-Related Risk Factors for Achilles Tendinopathy

摘要: 跟腱作为人体最强、最大、最厚的肌腱，也是人体使用最频繁的肌腱，病变概率相较其他肌腱更大，也更易被察觉。在诱发患者跟腱病(Achilles tendinopathy, AT)的众多危险因素中，药物因素的危险相关性被人们大大地低估了，结合我们目前搜集到的众多临床案例报告，有三种药物被频繁、集中地提及。根据现有研究，喹诺酮类药物和长期糖皮质激素治疗被认为是诱发跟腱病的主要药物危险因素，而他汀类药物的相关性则次之，但同样在文献中被广泛讨论。人们在日常生活及临床治疗中对这些广泛使用药物的这种潜在的严重不良反应的认识不足，因此，对药物相关性跟腱病的回顾应是及时的。药物性跟腱病变的具体病理生理机制目前仍未确定，但已证实的危险因素已被确定，如年龄超过60岁、肥胖以及几种药物联合使用时毒性作用的增强。出现症状的平均时间从喹诺酮类药物的几天到他汀类药物的几个月，长期糖皮质激素治疗的几年不等。本文在对药物相关性跟腱病的诱因、发病机制等方面研究进展进行综述，以期望为临床同仁们的合理用药提供参考，降低药物相关性跟腱损伤的风险。

Abstract: As the strongest, largest, and most frequently engaged tendon in the human body, the Achilles tendon demonstrates a higher susceptibility to pathological changes compared to other tendons, rendering its disorders more clinically detectable. Among the diverse risk factors for Achilles tendinopathy (AT), medication-related risks remain critically underrecognized. Drawing on the numerous clinical case reports we have collected so far, three medications have been frequently and consistently mentioned. According to current research, quinolones and long-term glucocorticoid therapy are recognized as the primary pharmacological risk factors for Achilles tendinopathy, while statins demonstrate a secondary but still extensively discussed association in the literature. There is a general lack of awareness regarding the potential serious adverse effects of these widely used medications in both daily life and clinical treatment. Therefore, a timely review of drug-induced tendinopathy is essential. The specific pathophysiological mechanisms of drug-induced tendinopathy remain undetermined, but established risk factors have been identified, such as age over 60, obesity, and enhanced toxicity when several medications are used in combination. The average time from medication use to symptom onset ranges from a few days for quinolones to several months for statins, and even several years for long-term corticosteroid therapy. This article reviews the recent progress in research on the etiology and pathogenesis of drug-induced tendinopathy, with the hope of providing a reference for rational drug use among clinical practitioners and reducing the risk of drug-induced tendon injury.