Lub raum muaj nuj nqi nyob rau hauv ib tug unselected Lithium Population
Mar 16, 2022
Yog xav paub ntxiv:ali.ma@wecistanche.com
H. Bendz, et al
TSAB NTAWV- Peb kawmraummuaj nuj nqinyob rau hauv 124 tus neeg mob luv luv thiab ntev lithium outpatients los ntawm cov pejxeem ntawm 127 tus neeg mob. Lub glomerular thiab distal tubular zog tau ntsuas thiab sib txheeb nrog ntau tus naj npawb ntawm cov pej xeem thiab kev kho mob. Muaj qhov cuam tshuam tsis zoo ntawm lub hnub nyoog thiab glomerular filtration rate. Tsis muaj lwm yam kev sib raug zoo. Tubular muaj nuj nqi qis dua li qub hauv 51 feem pua ntawm cov neeg mob. Kev ua haujlwm glomerular yog qis dua li qub hauv 3 feem pua ntawm cov neeg mob. Peb txiav txim siab tias kev kho lithium hauv cov tshuaj tsis muaj tshuaj lom cuam tshuamlub raum ua haujlwmthiab qhov ua haujlwm ntawm tubular cuam tshuam ntau dua li glomerular muaj nuj nqi. Tubular muaj nuj nqi tej zaum yuav zoo dua li peb cov duab qhia, glomerular function tsis zoo li. Hom kev npaj lithium tsis cuam tshuamlub raum ua haujlwmtxawv los yog tsis ua ke kev kho mob nrog neuroleptics.
Cov lus tseem ceeb: Lithium kev kho mob; kev npaj lithium; kev kho mob neuroleptic; tubular muaj nuj nqi; glomerular muaj nuj nqi.
Txij li thaum lithium tau qhia los ua kev kho mob rau kev puas siab puas ntsws, nws cov txiaj ntsig raulub raum ua haujlwmtau muaj kev txhawj xeeb. Polyuria, polydipsia, thiab txo qis kev tso zis muaj peev xwm yog ntawm cov teebmeem uas tau sau tseg (1). Cov teebmeem no tau raug suav tias thim rov qab (2-5). Txawm li cas los xij, xyoo 1975, Lindop & Pad teb (6) tau luam tawm ib rooj plaub ntawm cov ntshav qab zib nephrogenic insipidus mus tas li. Hestbech et al. (7) thiab Hansen et al. (8) tau kawm ib pab pawg neeg mob lithium, tau txais rau lithium intoxication lossis polyuria. Cov kws sau ntawv xav kom pom cov kev hloov pauv morphological ntawm tus cwj pwm mob tab sis pom cov kev hloov pauv mus ntev. Qhov kev tshawb pom no, qhia tias muaj peev xwm ua rau mob hnyav nephrotoxic ntawm kev kho lithium, tau nyiam thoob ntiaj teb thiab ua rau ntau qhov kev tshawb nrhiav ntawmlub raum ua haujlwm. Qhov kev tshawb nrhiav tam sim no tau ua nyob rau hauv lub tsev kho mob puas siab puas ntsws, Sahlgrenska Tsev Kho Mob, Gothenburg, Sweden, thiab tau npaj los teb cov lus nug hauv qab no:
1) Lithium puas ua rau muaj kev cuam tshuam ntawmlub raum ua haujlwm?
2) Puas yog tubular lossis glomerular muaj nuj nqi cuam tshuam?
3) Puas muaj kev sib txuas ntawm kev ntxhov siab thiab kev kuaj mob puas hlwb?
4) Puas muaj kev sib txuas ntawm qhov kev cuam tshuam thiab kev kho qhov hloov pauv?
5) Puas yog kev kho mob neuroleptic sib koom ua ke cuam tshuamlub raum ua haujlwm?
Khoom siv
Cov neeg mob.Qhov kev tshawb nrhiav tau pib thaum Lub Peb Hlis 1978. Tag nrho 127 tus neeg mob uas nyob rau hauv lithium tau suav nrog. Ib puas thiab nees nkaum plaub tau dhau los ntawm qhov kev pab cuam thaum kawg ntawm xyoo 1979. Cov uas tsis yog peb tus poj niam: ib tug yog manic thiab tawm hauv cheeb tsam. Ob tug tsis kam koom nrog tom qab kev txiav txim siab ntawm lawv cov endogenous creatinine clearance.
Kev sib deev thiab hnub nyoog. Saib Table 1.
Psychiatric kuaj mob. Saib Table 2.
Cov txheej txheem kuaj mob. Unipolar kev puas siab puas ntsws (UP) - tsawg kawg yog peb ntu ntawm kev nyuaj siab melancholic lossis tsis-melancholic. Kev puas siab puas ntsws bipolar (BP) - tsawg kawg ib lub voj voog ntawm kev nyuaj siab thiab kev mob siab (hypomania) lossis tsawg kawg ib ntu ntawm mania (9, 10). Cycloid psychosis (CP) - cov qauv raws li Perris (1 1). Unspecified affective disorder (US) - tsis ua raws li cov txheej txheem rau UP, BP, lossis CP. Schizophrenia (SP) - cov txheej txheem raws li Bleuler (12).
Kev kuaj mob yog hais txog qhov pib ntawm kev kho lithium. Thaum cov kev mob tshwm sim tau pom tseeb tias qhov kev kuaj mob thawj zaug tsis raug nws tau kho los ntawm peb.
Somatic kab mob.Tsis muaj tus neeg mob tau txais kev noj phenacetin. Plaub caug tus neeg mob tau tshaj tawm qee yam kab mob tso zis lossis kab mob plawv. Ntawm cov no, 15 tus neeg mob tau muaj keeb kwm ntawm tej zaum qhov chaw kho mob tseem ceebraum, mob plawv, lossis vascular disorder. Thaum lub sij hawm ntawm qhov kev tshawb fawb no, rau ntawm cov neeg mob muaj cov kab mob tseem ceeb uas tsis muaj cov tsos mob ntawm lub raum kev cuam tshuam. Ib tus neeg mob ntshav qab zib tau kho nrog cov tshuaj hypoglycemic ntawm qhov ncauj, peb tus neeg mob muaj cov ntshav siab diastolic ntawm 105 mmHg. Ib tug ntawm lawv tau noj tshuaj rau ntshav siab ua ntej kev tshawb nrhiav pib. Lwm plaub tus neeg mob tau noj tshuaj antihypertensive. Tsis muaj leej twg muaj kev cuam tshuam ntawm electrolyte tshuav.
Cov thyroid ua haujlwm.Kaum tus neeg mob tau noj tshuaj hloov cov thyroid (levothyroxine). Ob ntawm no thiab lwm tsib tau nce qib ntawm cov thyroid-stimulating hormone (TSH).
Maximal 12 h ntshav lithium.Five patients hid had at least one episode of serum lithium>2 0 meq/l.
Cov txheej txheem
Tsim
Tag nrho tab sis ib qho ntawm 124 tus neeg mob tau kuaj xyuas raws li cov neeg mob sab nraud los ntawm HB lossis SA Peb tau xam phaj cov neeg mob thiab tshuaj xyuas cov kab kos hais txog kev kuaj mob, lithium kev kho mob, neuroleptics, ntshav lithium, kev mob tshwm sim ntawm lithium kev kho mob, mob plawv thiab urinary kab mob hauv tus neeg mob. thiab nws cov txheeb ze, thiab noj phenacetin. Kev kuaj lub cev muaj xws li: palpation ntawm cov thyroid caj pas, ntshav siab (tus neeg mob pw), qhov siab, thiab qhov hnyav. Kev tshuaj ntsuam ntshav thiab zis tau ua tiav peb zaug sib cais ntawm 1 lub lis piam lossis ntau dua. Cov kev ntsuam xyuas hauv qab no tau ua tiav: 1) hauv cov ntshav: ntshav Hb, electrolytes (xws li Ca), lithium, TSH, thiab creatinine; hauv cov zis: protein, qabzib, lithium, creatinine, microscopy, kab lis kev cai, thiab 24-h ntim. 24 h endogenous creatinine tshem tawm tau suav nrog txoj hauv kev zoo tib yam. 2) DDAVP-test (13). 3) 51Cr-EDTA-clearance (14).
Cistanche raulub raum ua haujlwm
Serum creatinine tau kwv yees raws li kev kuaj mob niaj hnub.
Creatinine tshem tawm (CJ tsuas yog ua ib zaug xwb. Cov neeg mob tau sau 24-h tso zis hauv tsev. Txaus siab ua raws li xav tau hauv cov neeg mob uas tau tawm ntawm 70 thiab 110 feem pua ntawm nominal lithium koob tshuaj txhua hnub hauv lawv cov zis 24-h tso zis. Hauv qab no 90 m / min / 1.73 m2 raug kuaj xyuas los ntawm 51Cr-EDTA-txoj kev, thaum ua tau. Cov nqi siab dua 90 ml / min raug kuaj los ntawm 51Cr-EDTA-txoj kev yog tias peb xav tias qhov ua yuam kev hauv chav kuaj thiab rau cov neeg mob uas tau koom nrog hauv Kev tshawb nrhiav kev tshem tawm lithium
51Cr-EDTA-kev tshem tawm tau ua nrog tus neeg mob dag. Tsib caug xya tus neeg mob tau kuaj xyuas. Lawv tsis txawv ntawm tag nrho cov pejxeem txog poj niam txiv neej lossis hnub nyoog.
Maximal U-osmolality DDAVP-test tau ua raws li kev tswj hwm intranasal DDAVP tom qab 12 teev (dhau hmo) nqhis dej. Cov neeg mob tau noj lawv cov ntsiav tshuaj lithium kawg ua ntej lub sijhawm nqhis dej. Kev ua raws li txoj cai nqhis dej tsis tuaj yeem tswj tau. Osmolality tau ntsuas los ntawm cov txheej txheem khov rau hauv lub tshuab Roebling.
Txolub raum ua haujlwm. U-osmolality qis dua 800 mosmol (DDAVP-test) lossis glomerular filtration (GFR) hauv qab -2 SD rau hnub nyoog ntsuas los ntawm 51Cr-EDTA txoj kev (15).
Kev txheeb cais
Lub raum ua haujlwmCov txiaj ntsig (serum creatinine, endogenous creatinine clearance, 5ICr-EDTA-clearance, tso zis osmolality) tau cuam tshuam nrog poj niam txiv neej, hnub nyoog, kev kuaj mob, lub sij hawm ntawm lithium, qhov nruab nrab thiab siab tshaj cov ntshav lithium thaum lub sij hawm-on-lithium, tag nrho cov khoom noj lithium qhia. raws li cov khoom ntawm lub sij hawm-on-lithium thiab nruab nrab cov ntshav lithium, hom lithium npaj, kev kho mob neuroleptic thiab kev phiv ntawm lithium kev kho mob. Nees nkaum plaub-teev cov zis ntim tau cuam tshuam nrog cov zis osmolality. Kev txheeb xyuas qhov tseem ceeb tau raug sim los ntawm Tus Tub Kawm Ntawv t-test thiab regression tsom xam, kev tsom xam cov sib txawv, thiab ntau yam, kev txheeb xyuas cov kauj ruam. Qhov tseem ceeb ntawm 5 feem pua , 1 feem pua , thiab 0.1 feem pua tau raug xaiv nrog ib, ob, thiab peb lub hnub qub.
Ntau, stepwise regression tsom xam suav nrog raws li qhov sib txawv ntawm covlub raum ua haujlwm parameters mentioned above one by one and as independent variable age, average serum lithium, time-on-lithium, and the total amount of lithium ingested ex-pressed as the product of time-on-lithium and average serum lithium. The analysis was performed on the whole population (n=124) and on the following subgroups: all men (n=46), all women (n=78), all patients who underwent the 51CrEDTA examination (n=57), and all patients who excreted in their urine between 70 and 110 percent of nominal daily lithium dose (n=69). The subgroups did not differ in results from the whole population, which is, therefore, the only one presented.
Peb tau ua qhov kev soj ntsuam kev sib txawv los tshuaj xyuas cov teebmeem ntawm kev kho mob nrog neuroleptics thiab hom lithium npaj ntawm lub raum ua haujlwm; covariate yog hnub nyoog.
Qhov kev tshawb nrhiav no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Pawg Kws Kho Mob hauv Gothenburg.
Cov txiaj ntsig
Lub raum ua haujlwm
S-creatinine yog me ntsis siab dua li ib txwm nyob rau tsib ntawm 46 tus txiv neej cov neeg mob (ib txwm tsawg dua 120 pnoV1). Tag nrho cov no muaj ib txwm SICr-EDTA-kev tshem tawm. Qhov nruab nrab rau cov txiv neej yog siab dua cov poj niam (91 thiab 78 pmoV1 feem; t=5.37***). Tsis muaj qhov sib txawv ntawm hnub nyoog lossis pawg kuaj mob.
Nees nkaum-plaub-teev endogenous creatinine tshem tawm tau ploj mus rau ib qho ntawm 124 tus neeg mob thiab qis dua 90 ml / min hauv 18 tus txiv neej thiab 30 poj niam. Plaub caug-peb ntawm 48 tus neeg mob no tau dhau los ntawm kev kuaj SICr-EDTA. Cov nqi qis dua li qub tau pom hauv ob tus poj niam. Tsis muaj qhov sib txawv ntawm pawg kuaj mob.
Hauv 55 feem pua ntawm cov neeg mob uas endogenous creatinine clearance < 90="" ml="" min,="" tus="" nqi="" ntau="" dua="" tau="" sau="" tseg="" ntawm="" 51cr-edta-clearance.="" hauv="" yuav="" luag="" txhua="" tus="" neeg="" mob="" uas="" muaj="" cov="" tshuaj="" endogenous="" creatinine="" tshem="" tawm=""> 90 ml / min, tus lej qis dua tau sau tseg ntawm Wr-EDTA-clearance (Table 3).
51Cr-EDTA-clearance. There was no difference between diagnostic groups. Values were below normal in two male and two female patients. One man had been worked up for decreased renal function before he was seen by us. He was examined as an inpatient at the nephrological department, Sahlgrenska Hospital. Endogenous creatinine clearance and TSH were not done. The second man with a decreased SICr-EDTA-clearance had norma1 creatinine clearance (>90 m / min). Peb tau kawm tus txiv neej no lub raum ua haujlwm ua ib feem ntawm kev tshawb fawb txog lithium tshem tawm.
Tag nrho plaub tus neeg mob tsuas yog txo qis hauv GFR. Osmolality tau txiav txim siab txo qis hauv ob tus neeg mob, thiab me me lossis tsis nyob rau hauv ob. Cov neeg mob tau noj lithium rau 27 txog 80 lub hlis. Tsis muaj leej twg muaj keeb kwm ntawm lub raum tseem ceeb, muaj lithium intoxication, lossis nce TSH (saib Table 4).
Maximal osmolality. Cov nqi qis dua 800 mosm / kg H20 hauv 20 tus txiv neej thiab 43 tus poj niam cov neeg mob lossis 51 feem pua ntawm cov pejxeem. Nruab nrab ntawm pawg kuaj mob, tsis muaj qhov sib txawv. Rau ntawm xya tus neeg mob ntshav siab tau tso zis osmolality qis dua 800. Tag nrho cov ntawm lawv muaj GFR ib txwm muaj. Kaum tawm ntawm 15 tus neeg mob uas muaj mob raum lossis mob plawv tsis cuam tshuam nrog kev kho lithium muaj cov zis osmolality qis dua 800. Tag nrho cov ntawm lawv muaj GFR ib txwm muaj.
Nees nkaum plaub-teev tso zis ntim. Kaum tsib tus neeg mob tau polyuric (ntau tshaj 3,000 ml). Kaum ob ntawm cov no muaj cov zis ntau tshaj osmolality hauv qab 800 piv rau 47 ntawm 106 cov neeg mob uas tsis yog polyuric.
Kev nqhis dej tau tshaj tawm los ntawm 74 tus neeg mob ('cov neeg mob nqhis dej'). Lawv 24-h cov zis ntim (txhais tau tias=2.6 1) tau siab dua 37 tus neeg mob uas tsis qhia nqhis dej (txhais tau tias=1.8 1; t { {7}}.96***). Txhua tus neeg mob polyuric yws yws ntawm nqhis dej ib yam li qee cov neeg mob uas tsis yog polyuric. Qhov qis tshaj 24-h cov zis ntim txuam nrog nqhis dej yog 800 ml. Qhov siab tshaj plaws 24-h U-ntim hauv cov neeg mob uas tsis nqhis dej yog 2,600 ml. Cov zis osmolality hauv 79 tus neeg mob nqhis dej (txhais tau tias=721) tau qis dua li ntawm 40 tus neeg mob nqhis dej (txhais tau tias=816; t=3.02**).
Cov neeg mob tau muab faib ua peb pawg: 1) qhia tag nrho cov kev mob tshwm sim hauv qab no: nqhis dej, polyuria (subjectively), thiab tso zis ntau zaus (subjectively); 2) qhia tsis muaj cov kev mob tshwm sim no; 3) lwm tus. Tsis muaj qhov sib txawv ntawm pawg 1 thiab 2 hauv cov zis concentration.
Kev sib raug zoo ntawm kev ua haujlwm thiab kev kho mob sib txawv
Yooj yim sib raug zoo.Peb pom qhov kev cia siab tseem ceeb, kev sib raug zoo ntawm glomerular muaj nuj nqi thiab hnub nyoog. Tsis muaj lwm yam kev sib raug zoo tseem ceeb tau pom. Saib Table 5.
Kev sib raug zoo ntawm kev ntsuas ntawmlub raum ua haujlwm. Peb pom qhov cuam tshuam tsis zoo ntawm cov zis osmolality thiab ntim (r {{{0}}}}.51**), qhov kev sib raug zoo tseem ceeb ntawm cov zis osmolality thiab 51Cr-EDTA-clearance (r=ntxiv rau) 0.29 *, ib nrab correlation, kho rau hnub nyoog).
Kev tsom xam txog kev rov qab los
Ntau, kev soj ntsuam ntawm cov kauj ruam rov qab nrog plaub qhov kev ntsuas ntawm lub raum ua haujlwm raws li qhov hloov pauv tau pom tau tias muaj hnub nyoog ib leeg pab txhawb qhov sib txawv. Hnub nyoog muaj feem cuam tshuam nrog kev ntsuas ntawm glomerular muaj nuj nqi, tab sis tsis yog rau kev ntsuas ntawm tubular muaj nuj nqi (Table 6). Feem ntau, qhov sib txawv ntawm qhov tsis tshua muaj.
Table 6 Ntau yam kev hloov pauv ntawm lub raum tsis ua haujlwm ntawm plaub qhov kev kho mob (X). Ntau qhov sib txuas coefficient (R) thiab kev txiav txim siab coefficient (R2) ntawm kev taw qhia ntawm txhua X tshiab
Kev txheeb xyuas qhov sib txawv
Hom kev npaj lithium. Tag nrho cov pejxeem tau muab faib ua peb pawg, txhais raws li hauv qab no: 1) tsuas yog kho tau sai sai (RD) hom thaum tsawg kawg yog 90 feem pua ntawm lub sijhawm; 2) kho tsuas yog nrog qeeb-tso (SR) hom thaum tsawg kawg 90 feem pua ntawm lub sijhawm; 3) lwm tus. Covariance tsom xam ntawm thawj ob pawg nrog hnub nyoog raws li covariate tsis qhia qhov sib txawv ntawm plaub qhov kev ntsuas ntawm lub raum ua haujlwm. Yog li, hom kev npaj lithium zoo li tsis muaj qhov sib txawv ntawm lub raum ua haujlwm. Cov nyhuv ntawm lithium npaj rau osmolality yog qhia nyob rau hauv daim duab 1.
NeurolePtic kev kho mob. Tag nrho cov pej xeem tau muab faib ua peb pawg, txhais raws li hauv qab no: 1) kho nrog neuroleptics ntawm txhua yam (tshwj tsis yog rau dixyrazim thiab alimemazin) thiab txhua qhov ntau npaum li cas, rau tag nrho tsawg kawg 2 xyoo hauv lawv lub neej tag nrho; tsuas yog lub sijhawm kho mob tsawg kawg yog 1 lub lis piam tsis tu ncua tau suav nrog; 2) tsis kho nrog neuroleptics; kev kho mob txhais raws li saum toj no; 3) lwm tus.
Covariance tsom xam ntawm thawj ob pawg nrog hnub nyoog raws li covariate tsis qhia qhov txawv ntawm plaub qhov kev ntsuas ntawm lub raum ua haujlwm. Yog li, kev kho mob nrog neuroleptics zoo li tsis muaj kev cuam tshuam rau lub raum ua haujlwm. Cov nyhuv ntawm kev kho mob neuroleptic ntawm osmolality yog qhia hauv daim duab 2.
Kev sib tham
Qhov chaw ntawm kev ua yuam kev Peb tau tshuaj xyuas peb cov neeg mob nrog ntau yam kev kuaj sim. Ntxiv rau, peb tau xam phaj lawv. Peb pom tias ib tug xov tooj ntawm lawv tau pom cov cim tseem ceebraumkab mob. Tsis tas li ntawd, occultraumkab mob tsis zoo li yuav cuam tshuam peb cov txiaj ntsig mus rau ib qho kev kawm ntau heev.
Peb kos cov ntshav rau kev txiav txim siab lithium hauv 12 teev tom qab noj lithium zaum kawg thaum txoj kev tshawb no. Txawm li cas los xij, nws tau pom tseeb los ntawm cov kab kos uas ntau cov ntshav lithium yav dhau los tsis yog 12-h tus nqi. Peb xam qhov nruab nrab ntawm cov ntshav lithium qib uas siv tag nrho cov txiaj ntsig tom qab thawj lub hlis ntawm kev kho mob, txawm tias qhov tsis paub meej txog lub sijhawm ntawm cov ntshav kos ua rau qhov nruab nrab tsis meej. Serum lithium tau txiav txim siab ntau zaus hauv cov neeg mob hauv cov neeg mob ntau dua li cov neeg mob sab nraud, yog li cov neeg mob hauv tsev kho mob tau txais qhov hnyav dua qhov nruab nrab. Nws yog qhov tsim nyog tias qhov no yuav tsum yog qhov xwm txheej vim tias tus nqi hauv tus neeg mob muaj feem ntau yuav ua raws li 12-h txoj cai. Cov qib lithium los ntawm cov chaw kuaj mob uas tsis yog Sahlgrenska tau suav nrog.
Peb tau sib tham txog qhov muaj peev xwm kwv yees tag nrho cov lithium noj los ntawm kev siv daim ntawv teev cov ntaub ntawv, tab sis cov neeg mob ua raws li kev kho mob ntau xyoo yog qhov nyuaj rau kev soj ntsuam. Vim li no, tag nrho cov nyiaj lithium tau txhais raws li: txhais tau tias cov ntshav lithium multiplied by time on-lithium.
Kev kho mob nrog neuroleptics tsuas yog ntsuas raws sijhawm. Cov ntaub ntawv ntawm kev kho mob neurotic tau nyuaj rau kev rho tawm thiab txhais los ntawm cov kab kos dua li kev kho lithium. Lub sij hawm-on-neuroleptics yog li qhov ntsuas tsis paub meej dua li lub sijhawm-on-lithium. Txhawm rau txo qis kev cuam tshuam ntawm qhov tsis paub tseeb no, peb tau faib cov pej xeem mus rau ob pawg loj.
Cistanche raulub raum ua haujlwm
Cov txiaj ntsig
Peb tsis pom muaj kev sib raug zoo ntawmlub raum ua haujlwmthiab cov yam ntxwv ntawm tus neeg mob thiab cov kev kho mob hauv qab no: kev sib deev, kev kuaj mob, lub sij hawm-on-lithium, nruab nrab cov ntshav lithium, cov khoom ntawm ob lub tom kawg, cov ntshav lithium siab tshaj plaws, hom lithium npaj, thiab kev kho mob ua ke nrog neuroleptics. Peb pom qhov kev sib raug zoo ntawm lub hnub nyoog thiab GFR tab sis tsis nyob nruab nrab ntawm lub hnub nyoog thiab qhov siab tshaj osmolality.
Ntawm cov kev mob tshwm sim, qhia los ntawm tus neeg mob, (kev nqhis dej, polyuria, nce zaus) nqhis dej tuaj yeem yog qhov qhia txog kev txo qis kev muaj peev xwm lossis nce zis ntim.
Qee qhov kev tshawb pom tsis zoo no muaj qhov sib txawv nrog ntau qhov kev tshawb fawb zoo sib xws (16). Qhov no yog qhov tseeb tshwj xeeb ntawm lub sij hawm-onlithium uas nyob rau hauv yim ntawm 10 cov kev tshawb fawb tau pom tias muaj kev cuam tshuam loj thiab tsis zoo nrog ntau tshaj osmolality. Yog vim li cas rau qhov tsis sib xws yog tej zaum yuav pom nyob rau hauv DDAVP-test. Nws tsis tuaj yeem lav 12 xuab moos abstinence hauv cov neeg mob sab nraud. Qhov tsis ua raws li yuav ua rau muaj kev sib raug zoo ntawm lub sij hawm-on-lithium thiab osmolality maximal. Lwm qhov laj thawj los ntseeg tias peb txoj kev yuav ua rau muaj kev sib raug zoo ntawm cov ntaub ntawv tsis muaj zog yog qhov kev tshawb pom tsis muaj kev sib raug zoo ntawm hnub nyoog thiab osmolality.
Tus naj npawb ntawm cov neeg mob qis dua qhov kev txwv ib txwm muaj rau osmolality kuj yuav cuam tshuam los ntawm kev ua raws li tus neeg mob. Kev ua raws cai tsawg yuav ua rau tus lej ntawd nce ntxiv. Qhov kev txwv qis dua tau teeb tsa ntawm 800 mosm / kg H2O, zoo li lwm yam kev tshawb fawb zoo sib xws. Txij li thaum tubular muaj nuj nqi, zoo li glomerular muaj nuj nqi, ploj zuj zus nrog lub hnub nyoog, 800 txwv tuaj yeem raug nug tias yog siab dhau thiab nruj heev. Thaum kawg, peb cov ntaub ntawv qhia tias paub cov kab mob somatic tej zaum yuav muaj feem cuam tshuam rau kev txo qis osmolality. Peb, yog li ntawd, xaus lus tias peb qhov kev tshawb pom ntawm 51 feem pua ntawm cov neeg mob qis dua li ib txwm muaj ntawm DDAVP qhov kev sim muab cov duab tsis zoo ntawm cov tubular distal hauv cov pejxeem no.
Endogenous creatinine clearance yog ib qho kev ntsuas tsis txaus ntseeg ntawm glomerular muaj nuj nqi, tshwj xeeb tshaj yog thaum tus neeg mob khaws cov zis hauv tsev thiab tsuas yog ib zaug, ib yam li hauv peb txoj kev tshawb fawb. Txhawm rau them nyiaj rau qhov tsis muaj zog ntawm txoj kev, peb tau qhia txog SICr-EDTA-txoj kev ua cov cuab yeej kuaj xyuas. Qhov zoo dua, txoj kev ntawd yuav tsum tau siv rau txhua tus neeg mob. Qhov no tsis tau txiav txim siab ua tau thaum lub sijhawm saib ntawm lub peev xwm ntawm chav kuaj. Los ntawm kev tshuaj xyuas tsuas yog cov neeg mob uas poob qis dua 90 m / min ntawm creatinine tshem tawm, peb tau qhia txog kev tsis ncaj ncees hauv daim duab ntawm GFR. Qhov no yog qhia los ntawm Table 3, uas qhia tias endogenous creatinine tshem tawm feem ntau ua rau muaj txiaj ntsig ntau dua li SICr-EDTA-txoj kev. Qhov kev tshawb pom no tau lees paub los ntawm Wallin li al. (17) uas siv ob txoj kev hauv 185 tus neeg mob. Lawv pom tias tus nqi ntawm creatinine tshem tawm yog 23 feem pua siab dua qhov ntawd rau Wr-EDTA tshem tawm.
Tsis tas li ntawd, nrog rau peb txoj kev, peb tuaj yeem kho qhov txawv txav uas tsis tshua muaj thiab tsis muaj tseeb creatinine clearance qhov tseem ceeb. Cov txiaj ntsig tsis raug siab tsuas yog raug kho nyob rau hauv ob peb tus neeg mob thaum lwm tus yuav tau dim kev kho. Peb, yog li ntawd, txiav txim siab tias peb qhov kev tshawb pom ntawm plaub (3 feem pua) cov neeg mob uas muaj GFR me ntsis qis dua li ib txwm muab cov duab zoo heev ntawm glomerular muaj nuj nqi.
Thaj, lub cawv ntawm lithium tau tshaj tawm rau tubular dua li kev ua haujlwm glomerular. Qhov no yog raws li feem ntau lwm cov kev tshawb fawb. Kev sib tham dav dav ntawm qhov cuam tshuam ntawm txoj kev tshawb no raulub raum ua haujlwmthiab rau kev kho lithium raug ncua mus rau kev sib tham dav dav ntawm cov kev tshawb fawb ua tiavlub raum ua haujlwmhauv cov neeg mob lithium. Cov kev sib tham zoo li no tshwm sim nyob rau hauv qhov teeb meem no ntawm Acta Psychiatrica Scandinavica (16).
Cov lus xaus los ntawm qhov kev tshawb fawb tam sim no muaj feem xyuam rau cov lus nug pib
1) Lithium ua, hauv qee cov neeg mob, ua rau muaj kev cuam tshuam hauvlub raum ua haujlwm.
2) Concentrating peev xwm yog qhov ua haujlwm feem ntau cuam tshuam, thaum pom muaj peev xwm tsawg dua. Kwv yees li ib nrab ntawm peb cov neeg mob muaj qhov siab tshaj plaws U-osmolality qis dua 800 mosm / kg H2O, plaub tus neeg tau txo qis GFR raws li SICr-EDTA-txoj kev. Peb txoj hauv kev tsis tso cai rau kev txiav txim siab mus tas li ntawm kev cuam tshuam. Cov nuj nqis no tej zaum txhais tau hais tias qhov kev kwv yees qis ntawm tubular muaj nuj nqi, ib qho overestimate ntawm glomerular muaj nuj nqi.
3) Tsis muaj qhov sib txuam tseem ceeb ntawmlub raum ua haujlwmthiab kev kuaj mob puas hlwb.
4) Tsis muaj qhov sib txuam tseem ceeb ntawmlub raum ua haujlwmthiab cov kev hloov kho hauv qab no: nruab nrab cov ntshav lithium, lub sij hawm-on-lithium, thiab tag nrho cov lithium ingested (qhia raws li cov khoom ntawm ob qho ua ntej-hais). Vim cov txheej txheem ntawm kev ua yuam kev, xws li kev sib raug zoo yog, txawm li cas los xij, tsis suav nrog.
5) Kev npaj lithium sib txawv tsis cuam tshuamlub raum ua haujlwmtxawv.
6) Kev kho mob nrog neuroleptics tsis cuam tshuamlub raum ua haujlwm.
Cistanche khoom raulub raum ua haujlwm
Kev lees paub
Ntau, kev txheeb xyuas cov kauj ruam rov qab thiab kev txheeb xyuas qhov sib txawv tau ua los ntawm Steffan Ekblom thiab Christer Moller, Statistiska Forskningsgruppen, University of Stockholm, siv SPSS Batch System. Dr. Michael Feinberg, MD, Ph.D., ntawm Adult Psychiatric Department, University Hospital of Michigan, Ann Arbor, Michigan, USA, tau muab kev pab cuam tseem ceeb hauv kev txhais thiab kho cov ntawv no.
Los ntawm: 'Lub raum ua haujlwm hauv cov neeg tsis xaiv lithium' los ntawmH. Bendz, et al
---Acta Psychiatr. Luam theej duab. Xyoo 1983: 68: 325-334
Cov ntaub ntawv
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