Lan Chen-Chia, Liu Chia-Chien, Lin Ching-Heng, Lan Tzuo-Yun, McInnis Melvin G, Chan Chin-Hong, Lan Tsuo-Hung
Division of Psychiatry, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
Bipolar Disord. 2015 Nov;17(7):705-14. doi: 10.1111/bdi.12336. Epub 2015 Sep 23.
The risk of stroke is increased in patients with bipolar disorder. Lithium exhibits neuroprotective effects but the association between lithium use and the risk of stroke is unknown.
A population-based retrospective cohort study was conducted by utilizing the National Health Insurance Research Database in Taiwan. Subjects who had first been diagnosed with bipolar disorder between 2001 and 2006 were identified. A propensity score (PS) for receiving lithium was calculated with variables of age, gender, and comorbidities. The patients with bipolar disorder receiving lithium within the period from diagnosis through to December 2011 were designated as the lithium group (n = 635). A 1:2 ratio was used to select PS-matched subjects with bipolar disorder without lithium use (n = 1,250). Multivariate Cox proportional hazards regression models were used to explore the association, rather than causal inference, of lithium exposure and the risk of stroke.
Of the 1,885 subjects, 86 (4.6%) experienced stroke, including 2.8% of the lithium group and 5.4% of the non-lithium group. Lithium use was associated with a significantly reduced risk of stroke [hazard ratio (HR) = 0.39, 95% confidence interval (CI): 0.22-0.68]. Reduced risks of stroke were also associated with the highest cumulative lithium dose [≥720 defined daily dose (DDD), HR = 0.25, 95% CI: 0.10-0.59], the longest cumulative exposure period (≥720 days, HR = 0.20, 95% CI: 0.06-0.64), and the highest exposure rate (≥2 DDD/day, HR = 0.39, 95% CI: 0.21-0.70).
Lithium use was significantly related to a reduced risk of stroke in patients with bipolar disorder.
双相情感障碍患者中风风险增加。锂具有神经保护作用，但锂的使用与中风风险之间的关联尚不清楚。
利用台湾国民健康保险研究数据库进行一项基于人群的回顾性队列研究。确定2001年至2006年间首次被诊断为双相情感障碍的受试者。根据年龄、性别和合并症变量计算接受锂治疗的倾向评分（PS）。将2001年至2011年12月期间诊断后接受锂治疗的双相情感障碍患者指定为锂治疗组（n = 635）。采用1:2的比例选择PS匹配的未使用锂的双相情感障碍受试者（n = 1250）。使用多变量Cox比例风险回归模型探讨锂暴露与中风风险之间的关联，而非因果推断。
在1885名受试者中，86人（4.6%）发生中风，其中锂治疗组为2.8%，非锂治疗组为5.4%。锂的使用与中风风险显著降低相关[风险比（HR）= 0.39，95%置信区间（CI）：0.22 - 0.68]。中风风险降低还与最高累积锂剂量[≥720限定日剂量（DDD），HR = 0.25，95% CI：0.10 - 0.59]、最长累积暴露期（≥720天，HR = 0.20，95% CI：0.06 - 0.64）以及最高暴露率（≥2 DDD/天，HR = 0.39，95% CI：0.21 - 0.70）相关。
锂的使用与双相情感障碍患者中风风险降低显著相关。
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