Juurlink David N, Mamdani Muhammad M, Kopp Alexander, Rochon Paula A, Shulman Kenneth I, Redelmeier Donald A
Clinical Epidemiology and Healthcare Research Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2004 May;52(5):794-8. doi: 10.1111/j.1532-5415.2004.52221.x.
To study the association between hospital admission for lithium toxicity and the use of diuretics, angiotensin-converting enzyme (ACE) inhibitors, and nonsteroidal antiinflammatory drugs (NSAIDs) in the elderly.
Population-based nested case-control study.
Ontario, Canada.
Ontario residents aged 66 and older treated with lithium.
Estimated relative risk of hospital admission for lithium toxicity.
From January 1992 to December 2001, 10,615 elderly patients continuously receiving lithium were identified, of whom 413 (3.9%) were admitted to the hospital at least once for lithium toxicity. After adjustment for potential confounders, a dramatically increased risk of lithium toxicity was seen within a month of initiating treatment with a loop diuretic (relative risk (RR)=5.5, 95% confidence interval (CI)=1.9-16.1) or an ACE inhibitor (RR=7.6, 95% CI=2.6-22.0). Conversely, neither thiazide diuretics nor NSAIDs were independently associated with a significantly increased risk of hospitalization for lithium toxicity.
The use of loop diuretics or ACE inhibitors significantly increases the risk of hospitalization for lithium toxicity, particularly in naïve recipients.
研究老年患者因锂中毒住院与使用利尿剂、血管紧张素转换酶（ACE）抑制剂及非甾体抗炎药（NSAIDs）之间的关联。
基于人群的巢式病例对照研究。
加拿大安大略省。
66岁及以上接受锂治疗的安大略省居民。
锂中毒住院的估计相对风险。
1992年1月至2001年12月，共识别出10615名持续接受锂治疗的老年患者，其中413人（3.9%）因锂中毒至少住院一次。在对潜在混杂因素进行调整后，开始使用袢利尿剂（相对风险（RR）=5.5，95%置信区间（CI）=1.9 - 16.1）或ACE抑制剂（RR=7.6，95% CI=2.6 - 22.0）后一个月内，锂中毒风险显著增加。相反，噻嗪类利尿剂和NSAIDs均与锂中毒住院风险的显著增加无独立关联。
使用袢利尿剂或ACE抑制剂会显著增加锂中毒住院风险，尤其是在初治患者中。
