Cipriani Andrea, Pretty Heather, Hawton Keith, Geddes John R
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
Am J Psychiatry. 2005 Oct;162(10):1805-19. doi: 10.1176/appi.ajp.162.10.1805.
Observational studies suggest that long-term lithium treatment has a strong antisuicidal effect in mood disorders, but it is uncertain whether this association is a genuine therapeutic effect or is due to confounding factors in nonrandomized studies. The authors conducted a systematic review and meta-analysis of randomized trials to investigate the effect of lithium, compared to placebo and other active treatments, on the risk of suicide, deliberate self-harm, and all-cause mortality in patients with mood disorder.
The data source was the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register, incorporating results of searches of MEDLINE (1966-June 2002), EMBASE (1980-June 2002), CINAHL (1982-March 2001), PsycLIT (1974-June 2002), PSYNDEX (1977-October 1999), and LILACS (1982-March 2001). The Cochrane Central Register of Controlled Trials (CENTRAL) was searched with the term "lithium" for new records entered into the database from 1999 to 2003. Studies selected included randomized, controlled trials comparing lithium with placebo or all other compounds used in long-term treatment for mood disorders (unipolar depression, bipolar disorder, schizoaffective disorder, dysthymia, and rapid cycling, diagnosed according to DSM or ICD criteria). Of 727 references identified in the search, 52 articles were marked as possibly relevant on the basis of the abstract, and 32 randomized, controlled trials were eligible for inclusion in the review. Two independent reviewers extracted the data, and disagreements were resolved by consensus with a third reviewer. Methodological quality was assessed according to the criteria of the Cochrane Collaboration. When the outcomes of interest were not reported, an attempt was made to obtain the required data from the original authors.
In 32 trials, 1,389 patients were randomly assigned to receive lithium and 2,069 to receive other compounds. Patients who received lithium were less likely to die by suicide (data from seven trials; two versus 11 suicides; odds ratio=0.26; 95% confidence interval [CI]=0.09-0.77). The composite measure of suicide plus deliberate self-harm was also lower in patients who received lithium (odds ratio=0.21; 95% CI=0.08-0.50). There were fewer deaths overall in patients who received lithium (data from 11 trials; nine versus 22 deaths; odds ratio=0.42, 95% CI=0.21-0.87).
Lithium is effective in the prevention of suicide, deliberate self-harm, and death from all causes in patients with mood disorders.
观察性研究表明，长期锂盐治疗对心境障碍具有显著的抗自杀作用，但这种关联是真正的治疗效果还是由于非随机研究中的混杂因素所致尚不确定。作者进行了一项随机试验的系统评价和荟萃分析，以研究与安慰剂及其他活性治疗相比，锂盐对心境障碍患者自杀风险、蓄意自伤及全因死亡率的影响。
数据来源为Cochrane协作抑郁、焦虑与神经症对照试验注册库，纳入了对MEDLINE（1966年 - 2002年6月）、EMBASE（1980年 - 2002年6月）、CINAHL（1982年 - 2001年3月）、PsycLIT（1974年 - 2002年6月）、PSYNDEX（1977年 - 1999年10月）及LILACS（1982年 - 2001年3月）的检索结果。使用“锂盐”一词检索Cochrane对照试验中心注册库（CENTRAL），获取1999年至2003年录入该数据库的新记录。入选的研究包括随机对照试验，比较锂盐与安慰剂或用于心境障碍长期治疗的所有其他化合物（根据DSM或ICD标准诊断的单相抑郁、双相情感障碍、分裂情感性障碍、恶劣心境及快速循环）。在检索到的727篇参考文献中，52篇文章根据摘要被标记为可能相关，32项随机对照试验符合纳入本综述的条件。两名独立评审员提取数据，分歧通过与第三名评审员达成共识解决。根据Cochrane协作的标准评估方法学质量。当未报告感兴趣的结局时，尝试从原始作者处获取所需数据。
在32项试验中，1389例患者被随机分配接受锂盐治疗，2069例接受其他化合物治疗。接受锂盐治疗的患者自杀死亡可能性较小（来自7项试验的数据；2例自杀与11例自杀；比值比 = 0.26；95%置信区间[CI] = 0.09 - 0.77）。接受锂盐治疗的患者自杀加蓄意自伤的综合指标也较低（比值比 = 0.21；95% CI = 0.08 - 0.50）。接受锂盐治疗的患者总体死亡人数较少（来自11项试验的数据；9例死亡与22例死亡；比值比 = 0.42，95% CI = 0.21 - 0.87）。
锂盐对预防心境障碍患者的自杀、蓄意自伤及全因死亡有效。
