Kessing Lars Vedel, Gerds Thomas Alexander, Feldt-Rasmussen Bo, Andersen Per Kragh, Licht Rasmus W
Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
Bipolar Disord. 2015 Dec;17(8):805-13. doi: 10.1111/bdi.12344. Epub 2015 Nov 3.
A recent alarming finding suggested an increased risk of renal tumors among long-term lithium users. The objectives of the present study were to estimate rates of renal and upper urinary tract tumors (RUT), malignant and benign, among individuals exposed to successive prescriptions for lithium, anticonvulsants, and other psychotropic agents used for bipolar disorder, and among unexposed individuals.
This was a nationwide, population-based longitudinal study including time-specific data from all individuals exposed to lithium (n = 24,272) or anticonvulsants (n = 386,255), all individuals with a diagnosis of bipolar disorder (n = 9,651), and a randomly selected sample of 1,500,000 from the Danish population. The study period was from 1995 to 2012, inclusive. Outcomes were hazard rate ratios (HR) for RUT in three groups: (i) combined malignant and benign, (ii) malignant, and (iii) benign. Analyses were adjusted for the number of prescriptions for lithium/anticonvulsants, antipsychotic agents, antidepressants, and use of all other types of medication; age; gender; employment status; calendar year; and a diagnosis of bipolar disorder.
Continued treatment with lithium was not associated with increased rates of RUT [adjusted HR malignant or benign: 0.67-1.18, p (trend) = 0.70; adjusted HR malignant: 0.61-1.34, p (trend) = 0.90; adjusted HR benign: 0.74-1.18, p (trend) = 0.70]. Similarly, continued treatment with anticonvulsants was not associated with increased rates of RUT [adjusted HR malignant or benign: 0.97-1.18, p (trend) = 0.10; adjusted HR malignant: 0.82-1.15, p (trend) = 0.80; adjusted HR benign: 0.94-1.36, p (trend) = 0.20]. The associations were confirmed among the 9,651 patients with a diagnosis of bipolar disorder.
Treatment with lithium is not associated with increased rates of RUT.
最近一项令人担忧的研究结果表明，长期服用锂盐的人群患肾肿瘤的风险增加。本研究的目的是估计接受锂盐、抗惊厥药及其他用于双相情感障碍的精神药物连续处方治疗的个体以及未接受治疗的个体中肾及上尿路肿瘤（RUT）（包括恶性和良性）的发生率。
这是一项基于全国人口的纵向研究，纳入了所有接受锂盐治疗的个体（n = 24,272）或抗惊厥药治疗的个体（n = 386,255）、所有诊断为双相情感障碍的个体（n = 9,651）以及从丹麦人口中随机抽取的150万样本的特定时间数据。研究期间为1995年至2012年（含）。观察指标为三组RUT的风险率比（HR）：（i）恶性和良性合并；（ii）恶性；（iii）良性。分析对锂盐/抗惊厥药、抗精神病药、抗抑郁药的处方数量以及所有其他类型药物的使用情况、年龄、性别、就业状况、日历年份和双相情感障碍诊断进行了校正。
持续使用锂盐治疗与RUT发生率增加无关[校正后HR恶性或良性：0.67 - 1.18，p（趋势）= 0.70；校正后HR恶性：0.61 - 1.34，p（趋势）= 0.90；校正后HR良性：0.74 - 1.18，p（趋势）= 0.70]。同样，持续使用抗惊厥药治疗与RUT发生率增加无关[校正后HR恶性或良性：0.97 - 1.18，p（趋势）= 0.10；校正后HR恶性：0.82 - 1.15，p（趋势）= 0.80；校正后HR良性：0.94 - 1.36，p（趋势）= 0.20]。在9651例诊断为双相情感障碍的患者中也证实了这些关联。
锂盐治疗与RUT发生率增加无关。
