COMPARISON OF STANDARD AND LOW SERUM LEVELS OF LITHIUM FOR MAINTENANCE TREATMENT OF BIPOLAR DISORDER
COMPARISON OF STANDARD AND LOW SERUM LEVELS OF LITHIUM FOR MAINTENANCE TREATMENT OF BIPOLAR DISORDER
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DOI：
10.1056/nejm198911303212201
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发表时间：
1989-11-30
影响因子：
158.5
通讯作者：
LAVELLE, J
中科院分区：
文献类型：
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作者：
GELENBERG, AJ;KANE, JM;LAVELLE, J
近年来，建议使用较低的血清水平进行锂维持治疗。我们在一项随机、双盲、前瞻性试验中研究了 94 名双相情感障碍患者，使用两种不同剂量的锂进行维持治疗：调整为“标准”剂量，以达到每升 0.8 至 1.0 毫摩尔的血清锂浓度；以及“低”剂量，调整为每升 0.4 至 0.6 毫摩尔的血清锂浓度。标准范围组患者平均血清锂水平的组中位数为 0.83 mmol/L，低范围组患者为 0.54 mmol/L。 47 名患者中，有 6 名患者 (13%) 接受锂剂量治疗，使血清水平处于标准范围内，但在治疗期间病情复发，而 47 名患者中，有 18 名 (38%) 接受低剂量治疗。低范围组患者的复发风险比标准范围组患者高 2.6 倍（95% 置信区间，1.3 至 5.2）。标准范围组中的副作用，包括震颤、腹泻、尿频、体重增加和口腔金属味更常见。我们得出的结论是，导致血清锂水平为 0.8 至 1.0 mmol/L 的剂量在治疗双相情感障碍方面比导致血清锂浓度降低的剂量更有效，尽管较高剂量与较高的副作用发生率相关。关于锂有限肾毒性的最新发现以及我们的观察表明，医生应尝试将大多数双相情感障碍患者的血清锂水平维持在 0.8 至 1.0 mmol/L 之间，并应尝试增强患者对这一方案的理解和依从性。
In recent years, lower serum levels have been recommended for maintenance therapy with lithium. We studied 94 patients with bipolar disorder in a randomized, double-blind, prospective trial of two different doses of lithium for maintenance therapy: the "standard" dose, adjusted to achieve a serum lithium concentration of 0.8 to 1.0 mmol per liter, and a "low" dose, resulting in a serum concentration of 0.4 to 0.6 mmol per liter. The group medians of the patients'' average serum lithium levels were 0.83 mmol per liter for the patients in the standard-range group and 0.54 mmol per liter for those in the low-range group. Six of 47 patients (13 percent) assigned to receive lithium doses that would produce serum levels in the standard range had relapses while on protocol, as compared with 18 of 47 (38 percent) assigned to the low-dose range. The risk of relapse was 2.6 times higher (95 percent confidence interval, 1.3 to 5.2) among the patients in the low-range group than among those in the standard-range group. Side effects, including tremor, diarrhea, urinary frequency, weight gain, and a metallic taste in the mouth, were more frequent in the standard-range group. We conclude that doses resulting in serum lithium levels from 0.8 to 1.0 mmol per liter are more effective in treating bipolar disorder than those that result in lower serum lithium concentrations, although the higher doses are associated with a higher incidence of side effects. Recent findings about the limited nephrotoxicity of lithium, along with our observations, suggest that physicians should attempt to maintain serum lithium levels between 0.8 to 1.0 mmol per liter in most patients with bipolar disorder and that they should attempt to enhance patients'' understanding of and compliance with this regimen.