Saliva testing as a means to monitor therapeutic lithium levels in patients with psychiatric disorders: Identification of clinical and environmental covariates, and their incorporation into a prediction model.
Saliva testing as a means to monitor therapeutic lithium levels in patients with psychiatric disorders: Identification of clinical and environmental covariates, and their incorporation into a prediction model.
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DOI：
10.1111/bdi.13128
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发表时间：
2021-11
影响因子：
5.4
通讯作者：
Thomas, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Parkin, Georgia M.;McCarthy, Michael J.;Thein, Soe H.;Piccerillo, Hillary L.;Warikoo, Nisha;Granger, Douglas A.;Thomas, Elizabeth A.
锂药物狭窄的治疗窗口需要频繁的血清监测，这对患者来说既昂贵又不方便。与血液相比，唾液采集更容易，非侵入性，需要较少的处理，并且不需要训练有素的人员。本研究探讨了纵向唾液锂水平监测的实用性。我们使用ICP - OES测量了n = 169个被动唾液样本的唾液锂水平，这些样本收集自n = 75名双相情感障碍或其他精神疾病患者的多中心队列，包括单次观察和长达18个月的纵向观察。唾液和血清锂水平高度相关。调整每日锂剂量、糖尿病和吸烟后，这种关系得到改善（r = 0.77）。使用调整后的受试者间方程和患者唾液锂值，我们观察到预测与观察血清锂水平之间存在很强的相关性（r = 0.70）。大多数患者在多次就诊时唾液/血清比率高度稳定，随着年龄的增长，纵向变异性显著增加。使用来自单一先前观察的受试者内部唾液/血清比率与使用调整后的受试者间方程具有相似的预测能力。然而，使用来自三个先前观察的平均受试者内比率可以可靠地预测血清锂水平（预测与观察r = 0.90）。这些发现强烈表明，唾液可以用于锂监测，并为家庭或诊所使用的点护理唾液锂设备的开发和实施打开了大门。我们建议，唾液的使用将大大提高治疗机会，为患者的情绪障碍。
The narrow therapeutic window of lithium medications necessitates frequent serum monitoring, which can be expensive and inconvenient for the patient. Compared to blood, saliva collection is easier, non‐invasive, requires less processing, and can be done without the need for trained personnel. This study investigated the utility of longitudinal salivary lithium level monitoring. We measured salivary lithium levels using ICP‐OES in n = 169 passive drool samples, collected both as single observations and longitudinally for up to 18 months, from a multi‐center cohort of n = 75 patients with bipolar disorder or other psychiatric conditions. Saliva and serum lithium levels were highly correlated. Adjustment for daily lithium dose, diabetes, and smoking improved this relationship (r = 0.77). Using the adjusted intersubject equation and a patient's salivary lithium value, we observed a strong correlation between the predicted vs. observed serum lithium levels (r = 0.70). Most patients had highly stable saliva/serum ratios across multiple visits, with longitudinal variability significantly greater with age. Use of the intrasubject saliva/serum ratio from a single prior observation had similar predictive power to the use of the adjusted intersubject equation. However, the use of the mean intrasubject ratio from three prior observations could robustly predict serum lithium levels (predicted vs. observed r = 0.90). These findings strongly suggest that saliva could be used for lithium monitoring, and open the door for the development and implementation of a point‐of‐care salivary lithium device for use at home or the clinic. We propose that the use of saliva will dramatically improve treatment opportunities for patients with mood disorders.
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影响因子：
11.4
作者：
CADE, JFJ
通讯作者：
CADE, JFJ
影响因子：
12.6
作者：
Goldoni R;Farronato M;Connelly ST;Tartaglia GM;Yeo WH
通讯作者：
Yeo WH
DOI：
10.1159/000468563
发表时间：
1982-01-01
期刊：
INTERNATIONAL PHARMACOPSYCHIATRY
影响因子：
--
作者：
BOWDEN, CL;HOUSTON, JP;CLOTHIER, JM
通讯作者：
CLOTHIER, JM
影响因子：
3.8
作者：
Ozpoyraz, N;Tamam, L;Kulan, E
通讯作者：
Kulan, E
影响因子：
4.2
作者：
Kirkham, Emma;Bazire, Stephen;Desborough, James A.
通讯作者：
Desborough, James A.