碳酸锂抗躁狂症的临床应用进展及不良反应分析

doi:10.19803/j.1672-8629.2021.03.19

摘要/Abstract

摘要： 目的总结碳酸锂抗躁狂症的临床应用及安全性研究进展,为临床合理用药提供参考。方法对国内外有关碳酸锂临床应用及安全性的文献进行综述及分析比较。结果碳酸锂的治疗量与中毒量比较接近,易对神经系统、泌尿系统、内分泌系统、胃肠道系统等造成损害,甚至导致锂中毒;目前临床上多用碳酸锂联合其他抗精神病药物治疗躁狂症,且治疗期间往往需多次检测血锂浓度以保障用药安全性。结论碳酸锂仍是国内外预防及治疗躁狂症的一线药物,建议在临床用药中考虑与其他抗精神病药物联合应用,还应重视其不良反应的发生,根据血锂浓度及个体差异,促进合理用药。

关键词: 碳酸锂, 躁狂症, 联合用药, 不良反应, 血锂监测

Abstract: Objective To summarize the research progress in clinical application and safety of lithium carbonate used for mania, and to provide reference for clinical rational drug use. Methods Domestic and foreign literature on the clinical application and safety of lithium carbonate was reviewed for analysis and comparison. Results The treatment dose of lithium carbonate is close to the toxic dose, which is likely to cause damage to the nervous system, urinary system, endocrine system, gastrointestinal system, and even lithium poisoning. Lithium carbonate is currently often used in combination with other antipsychotic drugs in the treatment of mania, and the blood lithium concentration has to be detected many times during the treatment to ensure the safety of medication. Conclusion Lithium carbonate remains the first-line drug for the prevention and treatment of mania at home and abroad. It is suggested that the combination of lithium carbonate with other antipsychotics be considered in clinical medication. Attention should be paid to the occurrence of adverse reactions, and the rational use of drugs should be promoted according to the blood lithium concentration and individual differences.

Key words: lithium carbonate, mania, combination therapy, adverse reactions, blood lithium monitoring

中图分类号:

R964

戴慧, 李鸣, 端木彦涛, 王福东, 彭东明, 袁秀菊, 罗隽. 碳酸锂抗躁狂症的临床应用进展及不良反应分析[J]. 中国药物警戒, 2021, 18(3): 294-299.

DAI Hui, LI Ming, DUANMU Yantao, WANG Fudong, PENG Dongming, YUAN Xiuju, LUO Juan. Clinical Application and Adverse Reactions of Lithium Carbonate in Anti-mania[J]. Chinese Journal of Pharmacovigilance, 2021, 18(3): 294-299.

参考文献

[1] Ketter TA, Miller S, Dell'Osso B, et al. Treatment of bipolar disorder: Review of evidence regarding quetiapine and lithium[J]. J Affect Disord, 2016,191: 256-273.
[2] Malhi GS, Outhred T.Therapeutic mechanisms of lithium in bipolar disorder: recent advances and current understanding[J]. CNS Drugs, 2016, 30(10): 931-949.
[3] Zhong J, Lee WH.Lithium: a novel treatment for Alzheimer's disease[J].Expert Opin Drug Saf , 2007, 6(4): 375-383.
[4] Forlenza OV, Paula VJD, Machado-Vieira R, et al.Does lithium prevent Alzheimer's disease[J]. Drugs Aging ,2012; 29(5): 335-342.
[5] Tundo A, Filippis RD, Proietti L.Pharmacologic approaches to treatment resistant depression: Evidences and personal experience[J]. World J Psychiatry, 2015, 5(3): 330-341.
[6] Kitanaka N, Hall F, Uhl G, et al.Lithium pharmacology and a potential role of lithium on methamphetamine abuse and dependence[J]. Current Drug Research Reviews, 2019(11): 85-91.
[7] Mi J.Pharmacological effect and mechanism of MI Jun traditional Chinese medicine combined with lithium carbonate on calcium oxalate nephrolithiasis in rats [D] Lanzhou: Lanzhou University (兰州大学), 2010.
[8] Alda1 M. Lithium in the treatment of bipolar disorder: pharmacology and pharmacogenetics[J]. Molecular Psychiatry, 2015(11): 661-670.
[9] Costemale-Lacoste JF, Guilloux JP, Gaillard R.The role of GSK-3 in treatment-resistant depression and links with the pharmacological effects of lithium and ketamine: A review of the literature[J]. Encephale, 2016, 42(2): 156-164.
[10] Patel P, Woodgett JR.Glycogen synthase kinase 3: a kinase for all pathways[J]. Curr Top Dev Biol, 2017, 123: 277-302.
[11] Morlet E, Hozer F, Costemale-Lacoste JF.Neuroprotective effects of lithium: what are the implications in humans with neurodegenerative disorders[J]. Geriatr Psychol Neuropsychiatr Vieil, 2018, 16(1): 78-86.
[12] WHO. WHO Model list of essential medicines[EB/OL]. (2017-06)[2020-05-01]. https://www.esmo.org/oncology-news/WHO-Model-List-of-Essential-Medicines-Revised.
[13] Rej S, Pira S, Marshe V, et al.Molecular mechanisms in lithium associated renal disease[J]. Int Urol Nephrol, 2016, 48(11): 1843-1853.
[14] Severus WE, Kleindienst N, Seemüller F, et al.What is the optimal serum lithium level in the long-term treatment of bipolar disorder: a review[J]. Bipolar Disord, 2008(10): 231-237.
[15] Boyce P, Irwin L, Morris G, et al.Long-acting injectable antips-ychotics as maintenance treatments for bipolar disorder—acritical review of the evidence[J]. Bipolar Disorders, 2018, 20(suppl2): 25-36.
[16] Liu XF.Clinical study of quetiapine fumarate tablets combined with lithium carbonate in the treatment of manic episode of bipolar disorder[J]. Journal of Aerospace Medicine(航空航天医学杂志), 2017, 28(1): 57-60.
[17] Li C.Clinical application of aripiprazole[J]. World Latest Medical Information Digest(世界最新医学信息文摘), 2019, 19(98): 67-70.
[18] Wang CL.Objective to analyze the clinical effect of aripiprazole combined with lithium carbonate on patients with acute mania[J]. Chinese Practical Medicine(中国实用医药), 2019, 14(9): 134-135.
[19] Liu DM.Clinical effect of aripiprazole and lithium carbonate in the treatment of patients with acute manic episode[J]. Clinical Rational Drug Use(临床合理用药), 2018, 11(9): 39-40.
[20] Ding HY.Clinical effect and safety analysis of risperidone combined with lithium carbonate in the treatment of acute mania[J]. Henan Medical Research(河南医学研究), 2017, 26(8): 1459-1460.
[21] Dai J, Chen GR.Evaluation and analysis of risperidone combined with lithium carbonate in the treatment of mania[J]. Medical Theory and Practice(医学理论与实践), 2017, 30(20): 3015-3016.
[22] Pang SZ.Clinical effect of risperidone combined with lithium carbonate in the treatment of patients with acute mania[J]. Medical Journal of Chinese People's Health(中国民康医学), 2019, 31(17): 74-75, 89.
[23] Zhao QL, Jia F.Ziprasidone combined with lithium carbonate in the treatment of manic episode of bipolar disorder[J], Tianjin Pharmaceutical(天津药学), 2015, 27(2): 31-33.
[24] Zhang J.Ziprasidone combined with lithium carbonate in the treatment of 38 patients with bipolar disorder manic episode[J]. Capital Food and Medicine(首都食品与医药), 2019, 26(14): 89.
[25] Yuan YB, He ZF, Deng ZB.Effect of ziprasidone combined with lithium carbonate in the treatment of manic episode of bipolar disorder on serum neurotransmitters[J]. Contemporary Medicine(当代医学), 2019, 25(13): 37-39.
[26] Wu SJ.Objective to study the clinical efficacy and safety of zipra-sidone, clozapine and lithium carbonate in the treatment of mania[J]. Chinese Medical Guide(中国医药指南), 2019, 17(33): 106.
[27] Huang WL.Feasibility analysis of olanzapine combined with lithium carbonate in the treatment of bipolar disorder[J]. Contemporary Medicine(当代医学), 2018, 24(16): 123-125.
[28] Wen BL.Clinical observation of olanzapine combined with lithium carbonate in the treatment of manic episode of bipolar disorder[J]. Chinese and Foreign Medical Research(中外医学研究), 2020,18(2): 168-170.
[29] Xu D.Clinical effect of olanzapine combined with lithium carbonate in the treatment of bipolar disorder[J]. Chinese Medical Guide(中国医药指南), 2019, 17(26): 125-126.
[30] Zhang LL, Lin ZH.Efficacy analysis of olanzapine combined with lithium carbonate in the treatment of manic episode of bipolar disorder[J]. Jilin Medical Journal(吉林医学), 2019, 40(7): 1429-1430.
[31] Ge MF.Effects of quetiapine combined with lithium carbonate on cognitive function and liver function in patients with manic episode[J]. Contemporary Medical Review(当代医药论丛), 2019, 17(22): 140-141.
[32] Wang TT.Quetiapine combined with lithium carbonate in the treatment of bipolar disorder manic episode and cognitive function analysis[J]. Journal of Taishan Medical College(泰山医学院学报), 2020, 41(2): 117-119.
[33] Clark CT.Psychotropic drug use in perinatal women with bipolar disorder[C].Seminars in Perinatology. WB Saunders, 2020, 44(3): 151.
[34] Kong GQ, Guo W.Status and progress of lithium carbonate[J]. Chinese Journal of Clinical Pharmacy(中国临床药学杂志), 2009, 18(3): 183-185.
[35] Heath LJ, Billups SJ, Gaughan KM, et al.Risk Factors for Utilization of Acute Care Services for Lithium Toxicity[J]. Psychiatric Services, 2018, 12(6): 267-270.
[36] Westin AA, Brekke M, Molden E, et al.Changes in drug disposition of lithium during pregnancy: a retrospective observational study of patient data from two routine therapeutic drug monitoring services in Norway[J]. BMJ Open, 2017, 7(3): 157-168.
[37] Zhang S, Lin Q, Sun LW, et al.Analysis of 652 cases of adverse reaction reports of lithium carbonate[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2018, 15(4): 234-239.
[38] Zhuang HY, Guo W, Liu SS.Analysis of 16 cases of abnormal thyroid function caused by lithium carbonate[J]. China Pharmacist(中国药师), 2018, 21(9): 1613-1616.
[39] Dennison U, Clarkson M, O'Mullane J, et al. The incidence and clinical correlates of lithium toxicity: a retrospective review[J]. Ir J Med Sci, 2011,180(3): 661-665.
[40] Ott M, Stegmayr B, Salander RE, et al.Lithium intoxication: incidence, clinical course and renal function a population-based retrospective cohort study[J]. J Psychopharmacol, 2016(30): 1008-1019.
[41] Oakley PW, Whyte IM, Carter GL.Lithium toxicity: an iatrogenic problem in susceptible individuals[J]. Aust N Z J Psychiatry, 2001(35): 833-840.
[42] Phyu MH, Katherine ZI, Colin B, et al.Neurotoxicity in chronic lithium poisoning[J]. Internal Medicine Journal, 2020, 5: 426-432.
[43] Chan BS, Cheng S, Isoardi KZ, et al.Effect of age on the severity of chronic lithium poisoning[J]. Clinical Toxicology, 2020(8): 537-550.
[44] Yates G, Bass C.The perpetrators of medical child abuse(Munchausen Syn-drome by Proxy)- a systematic review of 796 cases[J]. Child Abuse Negl, 2017, 72: 45-53.
[45] Baird-GunningJ, Lea-HenryT, Hoegberg L, et al. Lithium poisoning[J]. J Intensive Care Med, 2017(32): 249-263.
[46] Pouchoux C, Pelissier AL, Gaulier JM, et al.Non accidental repeated lithium poisoning in a child: The role of hair analysis[J]. Arch pecliatr, 2020, 27(3):152-154.
[47] Wang X, Johansen S, Nielsen M, et al.Hair analysis in toxicological investigation of drug-facilitated crimes in Denmark over an 8-year period[J]. Forensic Sci Int, 2018, (285):e1-e12.
[48] Decker BS, Goldfarb DS, Dargan Pi, et al.Extracorporeal treatment for lithium poisoning: systematic review and recommendations from the EXTRIP workgroup[J]. CASN, 2015, 10(5):875-887.
[49] Du HY, Zhou HY.Nursing care of patients with lithium carbonate poisoning[J]. Contemporary Nurse(当代护士), 2019, 26(15): 123-124.
[50] Zhu J, Gong MG, Yang Z.Hemodialysis combined with acupuncture successfully rescued one case of lithium carbonate poisoning[J]. World Latest Medical Information(世界最新医学信息), 2019, 19(30): 286.