Kev sib raug zoo ntawm kev kho lithium thiab raum ua haujlwm

Yog xav paub ntxiv:Ali.ma@wecistanche.com

NYEEM NTXIV RAU 237 tus neeg mob hauv kev kho mob mus ntev

P. VESTERGAARD ​​THIAB A. AMDISEN

Ob xyoos tom qab qhov kev tshawb fawb ntawm covraummuaj nuj nqihauv 237 tus neeg mob tau muab sijhawm ntevlithiumkev kho mobcov neeg mob raug caw tuaj xyuas dua. Ntawm 184 tus neeg mob uas tuaj rau qhov kev kuaj xyuas 147 tau txuas ntxiv kho lithium; Hauv 37 tus neeg mob qhov kev kho mob tau raug txiav tawm. Cov neeg mob lithium-kho tau muab piv nrog ib pawg ntawm 68 tus neeg mob manic-depressive uas tab tom yuav tau txais kev kho mob lithium prophylactic tab sis tseem tsis tau pib.
Tsis yog cov neeg mob uas txuas ntxiv lossis cov neeg mob uas tau txiav tawm lithium tsis pom muaj qhov tsis zoo ntawm glomerular filtration rate raws li kev ntsuas los ntawm kev txiav txim siab ntawm 24-h creatinine clearance thiab cov ntshav creatinine concentration; txhais tau tias qhov tseem ceeb hauv cov neeg mob lithium-kho tau zoo ib yam li qhov tseem ceeb hauv cov neeg mob tseem tsis tau muab lithium. Kev puas tsuaj ntawm lub raum dej reabsorption, qhia los ntawm kev nce ntxiv 24-h cov zis ntim thiab txo cov zis osmolality tom qab DDAVP, tau nce ntxiv hauv cov neeg mob uas txuas ntxiv mus.lithiumkev kho mob, thiab ntau qhov kev ntsuam xyuas rov qab tau qhia txog lub sijhawm ntawm kev kho mob thiab qib ntshav lithium los ua qhov tseem ceeb ntawm kev kwv yees sib txawv. Hauv cov neeg mob uas tau txiav tawm lithium, kev hloov pauv hauv lub raum tuav dej tau txo qis. Cov zis ntim tau zoo ib yam li pom hauv cov neeg mob tseem tsis tau muab lithium; qhov siab tshaj plaws ntawm cov zis osmolality tsis tau ua tiav

normalized.

Cov kev mob tshwm sim xws li nqhis dej, nycturia, tshee, raws plab, edema, thiab qhov hnyav nce tau pom nrog tib zaus ntawm qhov thib ob raws li kev kuaj thawj zaug hauv cov neeg mob uas tau txuas ntxiv lithium. Hauv cov neeg mob uas tau txiav tawm lithium, lawv nquag lossis tsis tuaj.

Lo lus tseem ceeb:Lithiumkev kho mob- raummuaj nuj nqi- cov kev mob tshwm sim - desamino-8-D-arginine vasopressin (DDAVP) - creatinine tshem tawm - tso zis ntim - lub raum tsom rau lub peev xwm.

Cistancheyog qhov zoo rauraummuaj nuj nqi

Nyem rau organic Cistanche rau lub raum ua haujlwm

Hauv 1977/78 ib pawg ntawm 237 tus neeg mob tau muab sijhawm ntevlithiumkev kho mobntawm lub Tsev Kho Mob Psychiatric hauv Risskov, Denmark, tau raug kuaj xyuas thiab kuaj mob tshwj xeeb rauraummuaj nuj nqi. Tib pawg neeg mob tam sim no tau rov tshuaj xyuas dua xyoo 1979/80 txhawm rau kawm txog kev hloov pauv hauv lub raum ua haujlwm.

Peb tau tshuaj xyuas cov neeg mob uas tau txuas ntxiv muslithiumkev kho mob, tab sis peb kuj tau tshuaj xyuas cov neeg uas nyob rau lub sijhawm no tau txiav tawm lithium, txhawm rau kawm cov lus nug ntawm kev thim rov qab ntawm lub raum thiab lwm yam kev mob tshwm sim. Tsis tas li ntawd, thiab rau kev sib piv, peb tau kawm txog ib pawg ntawm cov neeg mob uas tab tom yuav muab prophylacticlithiumkev kho mobtab sis leej twg tseem tsis tau pib.

MATERIAL THIAB MUAB

Txhua tus neeg mob los ntawm qhov kev tshawb fawb thawj (hauv qab no hu ua Examination I) tau raug caw los ntawm tsab ntawv mus rau kev kuaj xyuas dua (Kev Xeem 11) uas, ntxiv rau cov sij hawm tshaj tawm yav dhau los (Vesterguurd et al. (1979)), suav nrog kev tshuaj xyuas lub raum tsom rau lub peev xwm. nrog des amino-8-D-arginine vasopressin (DDAVP). Hauv qhov kev sim no 20 pg ntawm DDAVP tau muab tshuaj intranasally, thiab qhov siab tshaj plaws ntawm cov zis osmolality tau txiav txim siab ntawm 1-h cov zis kuaj nrog cov txheej txheem khov. Kev tswj hwm ntawm DDAVP tau ua ntej los ntawm lub sijhawm 3-h nqhis dej tom qab los ntawm peb 1-h lub sijhawm sau cov zis thiab nqhis dej ntxiv (Vesterguurd & Hansen (1980)). Qhov kev sim pib thaum sawv ntxov tom qab cov neeg mob tau xa ib daim qauv 24-h cov zis thiab cov ntshav tau kos.

Ib yam li hauv kev ntsuam xyuas yav dhau los, cov ntsiab lus lithium hauv 24-h cov zis zoo sib xyaw tau raug txiav txim siab, thiab yog tias tsawg dua 75 feem pua ​​​​ntawm cov tshuaj lithium niaj hnub tau rov qab los, cov zis sau tau suav tias tsis tiav; Cov ntaub ntawv ntawm cov zis ntim, cov zis electrolyte cov ntsiab lus, thiab creatinine tshem tawm tau raug tsis lees paub.

Pawg tswj hwm suav nrog txhua tus neeg mob uas txij lub Ib Hlis 1, 1979, raug xa mus rau chav kuaj mob niaj hnub thiab kuaj mob ua ntej pib ua haujlwm.lithiumkev kho mobthiab leej twg tsis tau yav tas los nyob rau hauvlithiumkev kho mob. Lawv nyob rau hauv cov nram qab no xaiv "pre-lithium pawg". Kev tshuaj xyuas ntawm pawg neeg mob no suav nrog cov kev hloov pauv zoo ib yam li cov tshuaj ntsuam xyuas hauv cov neeg mob lithium-kho.

Cov zis thiab cov ntshav creatinine concentrations tau txiav txim siab nrog cov txheej txheem alkaline picrate ntawm ob qhov Kev Xeem I thiab Kev Xeem 11. Kev hloov pauv ntawm cov qauv sab nraud tau tshwm sim ntawm ob qhov kev xeem; cov txiaj ntsig ntawm qhov no tau tham tom qab. Cov ntshav lithium concentrations tau txiav txim siab nrog nplaim taws photometry thiab cov txiaj ntsig tau hais qhia tus qauv qauv tus nqi, 12h-stSLi (Arndisen (1980)). Cov zis lithium concentrations tau txiav txim siab nrog atomic absorption photometry (Amdisen (1975)). Cov txheej txheem tib yam tau siv rau ntawm Kev Xeem I thiab Kev Xeem II.

Cov ntaub ntawv tau muab khaws cia rau hauv lub regional EDP-Center ntawm Aarhus University (RECAU), thiab kev txheeb xyuas cov ntaub ntawv tau ua raws li cov ntaub ntawv txheeb cais rau social sciences (SPSS) computer program. Qhov sib txawv ntawm qhov nruab nrab ntawm peb pawg neeg mob tau sim nrog ib txoj kev tsom xam ntawm qhov sib txawv, ntawm ob pawg neeg mob sib txawv tau tshuaj xyuas tib lub sijhawm nrog qhov tsis sib xws t-test, thiab ntawm tib cov neeg mob kuaj lub sijhawm sib txawv nrog kev sib tw t-test. . Kev ntsuam xyuas rau qhov sib txawv ntawm cov proportions tau ua nrog rau kev xeem ntxiv.

Cistancheyog qhov zoo rauraummuaj nuj nqi

TSEEM CEEB

Tus neeg mob thiab kev kho mob nta

Ntawm 237 tus neeg mob kuaj hauv 1977/78, 184 tau tshwm sim rau kev rov kuaj dua thiab 53 tsis tau. Plaub tau tuag thaum txuas ntxiv muslithiumkev kho mob(peb tau tua tus kheej, ib tug tuag ntawm lub plawv nres), 14 tau tsiv tawm hauv tsev kho mob, thiab 35 tsis tuaj yeem tiv tauj lossis tsis xav rov kuaj dua. Cov pab pawg ntawm cov neeg mob tsis rov kuaj dua tsis txawv qhov txawv ntawm cov neeg uas tau tshuaj xyuas dua li hais txog poj niam txiv neej, hnub nyoog, qib ntshav lithium, lithium ntau npaum li cas, qib ntshav creatinine, creatinine tshem tawm, lossis 24-h cov zis ntim raws li sau tseg hauv Kev Xeem 1.

Ntawm 184 tus neeg mob uas tau rov kuaj dua, 147 txuas ntxiv muslithiumkev kho mobtsis muaj kev cuam tshuam, thiab cov no yog nyob rau hauv cov nram qab no xaiv "lithium pawg". Hauv 37 tus neeg moblithium kev kho mobtau raug txiav tawm thaum lub sijhawm 2 xyoos txij li thawj qhov kev xeem; Lawv tsim cov "post-lithium pawg". Yog vim li cas rau kev txiav tawm yog tias qhov kev kuaj mob tau hloov pauv, lossis tus neeg mob lossis tus kws kho mob xav tias qhov kev kho mob tsis zoo txaus. Tsis muaj ib qho piv txwv lithium raug txiav tawm vim tias tus neeg mob tau tsim lub raum tsis txaus.

Cov neeg mob thiab kev kho mob ntawm cov lithium pawg thiab cov pab pawg tom qab lithium tau qhia hauv Table 1, uas tseem nthuav tawm cov ntaub ntawv los ntawm pawg ua ntej lithium. Nws yuav raug muab sau tseg tias lithium regimen (nruab nrab lithium koob tshuaj thiab standardized 12-h sew lithium concentration) tseem yuav luag tsis hloov nyob rau hauv lub 2 xyoo ntawm Examination I thiab Examination 11. Cov neeg mob uas txiav lithium tsis txawv heev ntawm cov. leej twg txuas ntxiv lithium hais txog ib qho ntawm cov kev hloov pauv tau pom hauv Table 1; thiab lawv tsis txawv li cas txog qib ntshav creatinine, creatinine tshem tawm, lossis 24-h cov zis ntim raws li tau sau tseg hauv Kev Xeem I. Cov neeg mob hauv pab pawg ua ntej lithium nyob nruab nrab ntawm 6 xyoo yau dua.

Ntxiv nrog rau cov ntaub ntawv tau muab hauv Table 1, nws yuav tsum tau hais tias nyob rau hauv tag nrho peb pawg txog 90 feem pua ​​​​ntawm cov neeg mob tau kuaj pom tias yog tus neeg muaj kev nyuaj siab thiab 10 feem pua ​​​​yog kev txom nyem los ntawm tus mob schizophrenia lossis schizo-ffective. Lithium yog nyob rau hauv cuaj feem kaum ntawm cov neeg mob tau tswj hwm raws li kev tso tawm thiab hauv ib feem kaum li cov ntsiav tshuaj lithium carbonate. Yuav luag txhua tus neeg mob tau muab lithium hauv ob koob tshuaj txhua hnub. Hauv tag nrho peb pawg, kwv yees li ob feem peb ntawm cov neeg mob tau txais neuroleptics lossis tshuaj tiv thaiv kev ntxhov siab, lossis ob qho tib si.

Glomerular pom tus nqi

Kev sau cov zis ntau tau ua tiav los ntawm 118 ntawm cov neeg mob hauv pawg lithium.

Daim duab 1 qhia tau hais tias qhov kev tshem tawm creatinine yog kwv yees li 10 feem pua ​​qis dua ntawm Kev Xeem I1 dua li ntawm Kev Xeem I hauv ob pawg lithium thiab tom qab lithium. Qhov sib txawv no yuav tham tom qab. Qhov nruab nrab creatinine tshem tawm yuav luag zoo ib yam hauv ob pawg, 89.4 ml / min thiab 90.6 ml / min, raws li. Hauv pab pawg ua ntej lithium, qhov nruab nrab yog 94.9 ml / min. Kev kho tus nqi no rau lub hnub nyoog sib txawv ntawm 6 xyoo nrog kev kho ntawm 0.5 mumidyear ua rau tus nqi ntawm 91.9 ml / min; Qhov no tsis txawv txav ntawm qhov nruab nrab ntawm lithium thiab cov pab pawg tom qab lithium.

Kev hloov pauv ntawm glomerular pom tus nqi thaum lub sijhawmlithiumkev kho mobkuj tau kwv yees los ntawm kev txiav txim siab ntawm cov ntshav creatine concentration. Fig. 2 qhia tau hais tias cov pab pawg lithium thiab cov pab pawg tom qab lithium muaj qhov sib npaug nruab nrab ntawm cov ntshav creatinine qhov tseem ceeb, 1.04 thiab 1.01 mg/100 ml, feem. Cov txiaj ntsig no tau me ntsis, tab sis tseem ceeb, qis dua qhov pom ntawm Kev Xeem I; rau cov lithium pawg P yog <0.01 thiab="" rau="" cov="" pab="" pawg="" tom="" qab="" lithium="" p="" yog=""><0.05. tsis="" muaj="" qhov="" sib="" txawv="" tseem="" ceeb="" ntawm="" pawg="" lithium,="" pawg="" tom="" qab="" lithium="" thiab="" pawg="" ua="" ntej="" lithium="" (1.01="" mg="" 100="">

Ntau qhov kev ntsuam xyuas rov qab tau ua tiav nrog kev tshem tawm creatinine thiab ntshav creatinine raws li qhov sib txawv, thiab nrog hnub nyoog, poj niam txiv neej, ntshav lithium concentration, lithium ntau npaum li cas, thiab lub sijhawm ntawmlithiumkev kho mobraws li kev hloov pauv ywj pheej. Nyob rau hauv ob qho tib si tsom xam yog ib qho tseem ceeb kev sib raug zoo nrog lub sij hawm ntawm lublithiumkev kho mob.

Hauv peb tsab ntawv tshaj tawm txog cov txiaj ntsig ntawm Kev Tshawb Fawb, Kuv (Vestergaard et al. (1979)) ib pawg ntawm 26 tus neeg mob tau raug kev sib tham tshwj xeeb, vim tias lawv muaj creatinine tshem tawm qhov nqi qis dua 70 ml / min, lossis ntshav creatinine qhov tseem ceeb tshaj 1.3 mg / 100 ml, lossis tau pom tias muaj cov ntshav creatinine ntau dua 0.3 mg / 100 ml txij thaum pib kho. Table 2 qhia tau hais tias qhov tseem ceeb rau kev tshem tawm creatinine thiab ntshav creatinine ntawm Kev Xeem I thiab I1 rau 19 ntawm cov neeg mob no; 13 tau txuas ntxiv rau lithium thiab rau tau txiav tawm. Nyob rau hauv tsis muaj ib pawg twg yog qhov nruab nrab qhov tseem ceeb rau creatinine clearance qis dua los yog cov ntshav creatinine siab dua ntawm Examination I1 dua li ntawm Examination I. Nyob rau hauv tsis muaj tus neeg mob yog ib tug tseem ceeb deterioration ntawm glomerular function tau sau tseg nyob rau hauv lub 2 xyoo ntawm kev kuaj I thiab Examination 11. Qhov qis tshaj creatinine. Kev tshem tawm pom ntawm Kev Xeem I1 yog 31 ml / min thiab cov ntshav siab tshaj plaws creatinine yog 1.9 mg / 100 ml.

Lub cev tuav dej

Daim duab 3 qhia tau hais tias nyob rau hauv pawg lithium qhov nruab nrab cov zis ntim tau nce ntau heev (P < 0.01),="" los="" ntawm="" 2.87="" 1="" mus="" rau="" 3.17="" 1="" ntawm="" examination="" i="" thiab="" examination="" 11,="" whereas="" nyob="" rau="" hauv="" lub="" post-lithium="" pawg="" cov="" zis="" ntim="" tau="" txo="" qis="" heev="" (p="">< 0.02),="" los="" ntawm="" 2.80="" mus="" rau="" 2.19="" 1.="" qhov="" nruab="" nrab="" cov="" zis="" ntim="" hauv="" pawg="" lithium="" (3.17="" 1)="" yog="" qhov="" loj="" dua="" (p=""><0.01) ntau="" dua="" li="" hauv="" pawg="" lithium="" tom="" qab="" (2.19="" 1)="" nrog="" rau="" cov="" hauv="" pre-lithium="" pab="" pawg="" (2.00="" 1).="" cov="" pab="" pawg="" tom="" qab="" lithium="" ntawm="" kev="" xeem="" 11="" thiab="" cov="" pab="" pawg="" ua="" ntej="" lithium="" tsis="" dber="" tseem="">

Lwm qhov kev ntsuas tseeb ntawm lub raum tuav dej yog qhov siab tshaj plaws ntawm cov zis osmolality tom qab kev tswj hwm ntawm DDAVP. Hauv pab pawg lithium, 121 cov neeg mob ua tiav qhov kev ntsuam xyuas no raws li tau ua 32 hauv pawg tom qab lithium. Daim duab 4 qhia txog qhov siab tshaj plaws ntawm cov zis osmolalities hauv peb pawg ntawm Examination I1 (Kev kuaj kuv tsis suav nrog DDAVP-test). Qhov siab tshaj plaws ntawm cov zis osmolality tau qis dua (P < 0="" 01)="" hauv="" pawg="" lithium="" dua="" li="" hauv="" pawg="" lithium="" tom="" qab,="" thiab="" nws="" qis="" dua="" (p="">< 0.01)="" hauv="" cov="" lithium="" tom="" qab.="" pab="" pawg="" tshaj="" li="" hauv="" pab="" pawg="" ua="" ntej="">

Kev soj ntsuam ntau yam tau ua tiav nrog qhov siab tshaj plaws ntawm cov zis osmolality raws li qhov sib txawv, thiab hnub nyoog, poj niam txiv neej, ntshav lithium, lithium ntau npaum li cas, lub sijhawm ntawm kev kho mob, lithium npaj, kev kho concomitant nrog neuroleptics, thiab kev kho concomitant nrog antidepressants raws li kev ywj pheej. Muaj qhov cuam tshuam tsis zoo ntawm lub raum kom muaj peev xwm ntawm ib sab thiab qib ntshav lithium (P < {{0}}.001)="" thiab="" lub="" sijhawm="" kho="" (p="">< 0.001)="" ntawm="" lwm="" qhov.="" tsis="" muaj="" kev="" sib="" raug="" zoo="" tseem="" ceeb="" ntawm="" lub="" raum="" tsom="" lub="" peev="" xwm="" thiab="" ib="" qho="" ntawm="" lwm="" yam="" kev="" hloov="" pauv="" ywj="">

Lwm cov kev mob tshwm sim tseem ceeb hauv chaw kho mob

Hauv pawg lithium cov ntaub ntawv rau kev tsis txaus siab ntawm kev nqhis dej ntau ntxiv (68%), nycturia (18%), tshee (37 feem pua), edema (17 feem pua), thiab raws plab (16 feem pua) zoo ib yam li cov uas tau ntsib hauv Kev Xeem I (Vestergaard thiab. ib. (1980)). Kev nce me ntsis tau pom nyob rau hauv nruab nrab lub cev qhov hnyav hauv pawg lithium. Hauv pawg lithium tom qab, tsuas yog 30 feem pua ​​​​ yws yws ntawm kev nqhis dej ntau ntxiv. Nycturia, tshee, edema thiab raws plab tau tshwm sim nyob rau hauv ib mus rau peb ntawm 37 tus neeg mob. Hauv pawg no, qhov nruab nrab qhov hnyav ntawm 2.5 kg tau tshwm sim. Hauv pab pawg ua ntej lithium, 20 feem pua ​​​​ntawm cov neeg mob tau tshaj tawm qhov nqhis dej hnyav thiab tsis muaj rau ob tus neeg mob ntawm 68 yws yws ntawm nycturia, tshee, edema, lossis raws plab. Hauv pab pawg no, qhov nruab nrab lub cev hnyav yog 69.7 kg, uas yog qis dua li ntawm lithium thiab cov pab pawg tom qab lithium.

Cistancheyog qhov zoo rauraummuaj nuj nqi

Kev sib tham

Cov neeg mob uas tsis tau tig mus rau qhov kev ntsuam xyuas rov qab tsis sib txawv ntawm cov ntaub ntawv tseem ceeb ntawm cov kev hloov pauv tseem ceeb los ntawm cov neeg tuaj rau qhov kev ntsuam xyuas no; cov pab pawg tom kawg tuaj yeem suav tias yog tus sawv cev ntawm cov khoom siv tag nrho.

Kwv yees li 15 feem pua ​​​​ntawm cov neeg mob txiav tawm lithium ntawm Examhation I thiab Examination II. Cov neeg mob no tsis txawv raws li kev txheeb cais ntawm cov neeg uas txuas ntxiv lithium raws li hnub nyoog thiab poj niam txiv neej. Tsis yog ob pawg sib txawv ntawm cov yam ntxwv hauv qab no ntawm Kev Xeem I: lithium ntau npaum, ntshav lithium concentration, lub sijhawm ntawmlithiumkev kho mob, creatinine tshem tawm, ntshav creatinine concentration, zis ntim, lossis lub cev hnyav. Lithium-induced kev hlub ntawm lub raum kev ua haujlwm, yog li ntawd, tsis zoo li cuam tshuam rau kev txiav tawm ntawm lithium, uas yog raws li kev tsis txaus siab ntawm qhov kev kho mob.

Hauv ob pawg lithium thiab cov pab pawg tom qab lithium qhov nruab nrab creatinine tshem tawm tau qis dua 10 feem pua ​​​​ntawm Kev Xeem II dua li ntawm Kev Xeem I, thiab qhov no yuav raug coj los ua qhov qhia tau tias 20 lub hlis ntxiv ntawmlithiumkev kho mobnruab nrab ntawm Kev Xeem I thiab Kev Xeem I1 (6 lub hlis hauv pawg tom qab lithium) tau ua rau poob ntawm cov neeg mob lub glomerular filtration rate. Qhov kev xav zoo li no, txawm li cas los xij, tsis sib xws nrog ntau yam kev soj ntsuam: 1) Tsis yog nrog cov ntaub ntawv los ntawm Kev Tshawb Fawb Kuv lossis nrog cov ntaub ntawv los ntawm Kev Xeem I1 tau ua lub sijhawm ua haujlwm.lithiumkev kho mobpab txhawb kev nce qib hauv ntau qhov kev ntsuas rov qab nrog creatinine tshem tawm raws li qhov sib txawv ntawm qhov sib txawv. 2) Ntawm Kev Xeem I1 qhov txhais tau tias kev tshem tawm creatinine tsis sib txawv ntawm cov neeg mob uas txuas ntxiv lithium thiab cov neeg mob uas tau txiav lithium. Cov neeg mob uas tseem tsis tau pib lithium muaj me ntsis, tab sis tsis tseem ceeb, siab dua txhais tau tias creatinine tshem tawm; kev kho rau lawv cov hnub nyoog qis me ntsis ua rau tib lub ntsiab lus clearance ib yam li lwm pab pawg. 3) Lub caij nplooj zeeg ntawm creatinine tshem tawm ntawm Kev Xeem I thiab Kev Xeem I1 yuav tsum tau ua kom nce qib ntawm cov ntshav creatinine concentration los ntawm thawj zaug mus rau qhov kev kuaj thib ob; es tsis txhob me me, tab sis tseem ceeb, poob ntawm cov ntshav creatinine tau pom.

Cov kev soj ntsuam no qhia tau hais tias qhov sib txawv ntawm qhov txhais tau tias creatinine tshem tawm ntawm Kev Xeem I thiab Kev Xeem I1 tsis cuam tshuam txog lithium-induced qis qis ntawm cov neeg mob glomerular filtration rate tab sis yog qhov tshwm sim ntawm kev hloov pauv hauv creatinine kev soj ntsuam txheej txheem ntawm ob qhov kev kuaj. Raws li nws tau hais nyob rau hauv Cov Txheej Txheem, kev hloov pauv ntawm cov txheej txheem tau ua, qhov tseeb, tshwm sim, txawm tias thaum lub sijhawm peb tsis paub tias nws cuam tshuam nrog kev hloov pauv ntawm cov txiaj ntsig kev tshuaj ntsuam. Kev rov kuaj dua ntawm ob txoj haujlwm tam sim no tau qhia tias cov txheej txheem tshiab muab cov txiaj ntsig creatinine hauv cov ntshav uas muaj kwv yees li qub thiab cov zis creatinine qhov tseem ceeb uas yog kwv yees li 10 feem pua ​​​​qis dua li cov txheej txheem qub. Qhov sib txawv no suav nrog qhov sib txawv ntawm creatinine clearances ntawm ob qhov kev ntsuam xyuas.

Tsis yog nyob rau hauv peb pab pawg neeg tag nrho los yog nyob rau hauv cov pab pawg me ntawm cov neeg mob uas nyob rau hauv kev ntsuam xyuas kuv muaj marginally tsawg pom tus nqi puas tau ib tug neeg mob raug kev poob rau hauv creatinine clearance los yog ib tug cim nce nyob rau hauv cov ntshav creatinine thaum lub sij hawm.lithiumkev kho mob. Qhov kev tshawb pom ntawm qhov kev tshawb fawb tam sim no tau lees paub cov kev tshawb fawb thawj zaug (Vestergaurd et al. (1979)) nrog rau ntau yam kev tshawb fawb (xws li Albrecht et al. (1980), Coppen & Cattell (1980), Hansen et al. . (1979), Hullin et al. (1979), Rafaelsen et al. (1979)). Txawm tias thaum siv ntau xyoo lithium kev kho mob tsis ua rau txo qis ntawm glomerular pom tus nqi. Thaum qee zaus glomerular pom tus nqi qis tuaj yeem pom ntawm cov neeg mob hauv kev kho lithium, qhov no yuav yog vim muaj ob peb tus neeg idiosyncratic, mus rau lub raum kab mob ua ntej kev kho lithium pib, lossis kev txhim kho ntawm lub raum kab mob. yog ywj siab ntawm kev kho lithium.

Peb txoj kev tshawb fawb ntxiv tau lees paub qhov kev tshawb pom yav dhau los ntawm qhov cuam tshuam ntawmlithium kev kho mobntawm lub raum dej reabsorption (xws li Albrecht et al. (1980), Buchr & Wahlin (1980), Hansen et al. (1979), Hullin et al. (1979), Rafaelsen et al. (19791, Vestergaurd et al. (1979) )). Cov neeg mob uas txuas ntxiv muslithiumkev kho mobmuaj qhov tso zis ntau dua ntawm Kev Xeem I1 dua li ntawm Kev Xeem I; lawv lub raum tsom lub peev xwm tau qis dua li cov neeg mob tseem tsis tau muab lithium; thiab ntau regression tsom xam ntawm cov ntaub ntawv los ntawm Examination I1 qhia, raws li tau ua ib qho kev soj ntsuam ntawm cov ntaub ntawv los ntawm Examination I, hais tias lub sij hawm ntawm kev kho mob lithium. txhawb nqa qhov kev rov qab los thaum cov zis ntim los yog siab tshaj osmolality yog qhov sib txawv. Yog li, thaum cov tsev kho mob sib txawv tshaj tawm cov duab sib txawv ntawm qhov nruab nrab 24-h cov zis ntim thiab cov zis ntau tshaj osmolality hauv cov neeg mob tau txais kev kho mob mus sij hawm ntev nrog lithium, nws yuav xav tias qhov sib txawv no tsis yog vim qhov sib txawv ntawm lub sijhawm ntev. kev kho mob tab sis kuj rau d8erences hauv cov ntshav lithium. Hauv txoj kev tshawb no, hauv kev kawm ntawm Albrecht et al. (1980).

Kev txheeb xyuas ntau yam kev hloov pauv, uas cov neeg mob tseem ceeb thiab kev kho mob hloov pauv tau tswj hwm, tsis tau lees paub cov lus qhia ua ntej uas kev kho mob nrog neuroleptics (Bucht & Wahlin (1980)) thiab hom lithium npaj (Wallin & Alling (1979)) tseem ceeb cuam tshuam rau lub raum. tuav dej.

Ib qho tshiab ntawm kev tshawb fawb tam sim no yog tias nws suav nrog kev tshuaj xyuas cov neeg mob uas tau txiav cov lithium; Lub sijhawm nruab nrab ntawm kev txiav tawm ntawm lithium thiab Kev Xeem I1 yog 14 lub hlis. Hauv pab pawg no, qhov nruab nrab cov zis ntim tau qis dua thiab qhov siab tshaj plaws ntawm cov zis osmolality markedly siab dua li cov neeg mob uas txuas ntxiv rau lithium. Ntawm qhov tod tes, qhov siab tshaj osmolality tsis tau mus txog qib pom hauv cov neeg mob tseem tsis tau muab lithium; cov zis ntim yuav luag ua. Cov kev tshawb pom no qhia tau hais tias lithium-induced impairment ntawm lub raum dej reabsorption reversible txawm nyob rau hauv cov neeg mob uas tau muab lithium rau ntau xyoo. Ntawm qhov tod tes, kev txhim kho yog qeeb; nyob rau hauv peb cov neeg mob nws tsis tiav 13 lub hlis tom qab lithium raug txiav. Peb qhov kev tshawb pom tau pom zoo nrog qhov kev tshawb pom ntawm Bucht & Wahlin (1980), uas tau txiav txim siab lub raum tsom rau lub peev xwm 12 lub hlis tom qab txiav tawm ntawm lithium. Nws yog ib qho tseem ceeb uas cov kev mob tshwm sim xws li nqhis dej, nycturia, tshee, edema, thiab raws plab, feem ntau pom nyob rau hauv cov neeg mob uas tau txais kev kho mob lithiurn ntev (Vestergaard et al. (1980), Bech et al. (1976)), yuav luag. ploj hauv cov pab pawg tom qab lithium. Cov kev tsis txaus siab no yog qhov tseeb tsis tau sau npe ntau zaus hauv pawg tom qab lithium dua li hauv pawg ua ntej lithium. Qhov hnyav nce thaum lub sijhawmlithiumkev kho mobfeem ntau ua rau muaj kev txhawj xeeb, tshwj xeeb tshaj yog rau cov poj niam cov neeg mob. Kev txo qhov hnyav tau pom nyob rau hauv cov pab pawg tom qab lithium sib npaug rau qhov txo qis ntawm nqhis dej thiab polyuria, tab sis qhov nruab nrab qhov hnyav ntawm cov neeg mob tom qab lithium tseem tseem siab dua li cov neeg mob lithium. Peb npaj yuav ua raws li cov neeg mob tom qab lithium ntxiv nrog rau kev rov kuaj xyuas cov zis ntim, kom muaj peev xwm, thiab lub cev hnyav ntawm lub sijhawm.

TXOJ CAI

Peb ua tsaug rau Danish Medical Research Council rau kev txhawb nqa nyiaj txiag thiab muab kev pab tswv yim txog kev txheeb cais.

Cistancheyog qhov zoo rauraummuaj nuj nqi

REFERENCES

Albrecht, J., D. Kampf & B. Miiller-Oerlinghausen (1980): Lub raum ua haujlwm thiab kev kuaj ntshav hauv cov neeg mob ntawm lithium-kev kho. Pharmacopsychiat. 13, 228-234, ib.

Amdisen, A. (1975): Kev kwv yees lithium hauv cov zis. Hauv Johnson, FN (ed.): Lithium kev tshawb fawb thiab kev kho mob. Academic Press, London, New York-San Francisco, pp. 181-195.

Amdisen, A. (1980): Serum concentration thiab kev saib xyuas kev kho mob hauv kev saib xyuas ntawmlithiumkev kho mob. Ther. Yeeb Yaj Kiab 2, 73-83.

Bech, P., PB Vendsborg & 0. J. Rafuelsen (1976): Lithium kev kho mob ntawm cov neeg mob manic-melancholic: Nws lub luag haujlwm hauv kev ua haujlwm niaj hnub. Acta Psychiat. Luam theej duab. 53, 4, XIV. 345

Bucht, G., & A. Wahfin (1980): Lub raum tsom rau lub peev xwm mus ntevlithiumkev kho mobthiab tom qab tshem tawm ntawm lithium. Acta med. Luam theej duab. 207, 309-314, ib.

Coppen, A., & WR Cattell (1980): Lithium thiab lub raum. Brit, med. J. ii, 61. Hansen, HE, J. Hestbech, JL S#rensen, K. N#rgaard, J. Heilskov & A. Amdisen (1979): Chronic interstitial nephropathy hauv cov neeg mob mus sij hawm ntevlithiumkev kho mob.

Hullin, RP, VP Coley, NJ Birch, TH Thomas & DB Morgan (1979): Lub raum ua haujlwm tom qab kev kho mob ntev nrog lithium. Brit. med. J. I, 1457-1459.

Rafaelsen, 0. J., TG Bolwig, I. Ladefoged & C. Brun (1979):Lub raummuaj nuj nqithiab morphology nyob rau hauv lub sij hawm ntevlithium kev kho mob. Cooper, TB, S. Gershon, NS

Kline & M. Schou (eds.): Lithium: controversies thiab unresolved teeb meem. Excerpta Medica, New York, pp. 578-583.

Thomen, K. (1976): Lub raum tshem tawm ntawm lithium hauv nas nrog lithium intoxication. J. Pharmacol. exp. Ther. Z99, 483-489.

Vestergaard, P., & HE Hansen (1980): Kev soj ntsuam ntawm lub raum tsom lub peev xwm hauv cov neeg mob lithium-kho: Kev sib piv ntawm lub cev qhuav dej ntev nrog kev tswj hwm ntawm vasopressin analog. Acta Psychiat. Luam theej duab. 61, 152-156.

Vestergaard, P., A. Amdisen & M. Schou (1980): Clinically tseem ceeb phiv ntawmlithiumkev kho mob: Kev tshawb fawb ntawm 237 tus neeg mob hauv kev kho mob mus ntev. Acta Psychiat. Luam theej duab. 62, 193-200} ib.

Vestergaard, P., A. Amdisen, HE Hansen & M. Schou (1979):Lithiumkev kho mobthiabraumlom zemction: Kev tshawb fawb ntawm 237 tus neeg mob hauv kev kho mob mus ntev. Acta Psychiat. Luam theej duab. 60, 504-520.

Wallin, L., & C. Alling (1979): Cov txiaj ntsig ntawm kev tso tawm cov ntsiav tshuaj lithium rau lub raum ua haujlwm. Brit. med. Ib., 1332.