锂盐对双相障碍患者甲状腺功能的影响

Effect of lithium on thyroid function of patients with bipolar disorders

目的研究锂盐对双相障碍患者甲状腺功能的影响。方法131例双相障碍患者分为非锂盐组(78例,未用过碳酸锂),锂盐组(53例,用过碳酸锂)。观察两组患者血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)和促甲状腺激素(TSH)的变化。结果非锂盐组甲状腺功能减退率明显低于锂盐组(躁狂:6.3%vs.28.0%,P<0.05;双相抑郁:10.8%vs.32.1%,P<0.05)。非锂盐组中躁狂患者长病程(>60个月)与甲状腺功能减退有明显的相关性;躁狂患者血清TSH与病程呈正相关;双相抑郁患者T4水平降低与发作次数有关。锂盐组躁狂患者严重程度和发作次数与甲状腺功能减退有明显的相关性;双相抑郁患者T3水平降低与性别有关,TSH水平升高与长病程有关。结论双相障碍患者非锂盐组及锂盐组的双相障碍患者在流行病学及甲状腺功能减退方面有明显的差异。

Objective To determine whether there were differences in thyroid profile between lithium-free and treated bipolar patients. Methods Bipolar patients never treated with lithium and （n = 78） and in lithium therapy （n=53） were included. Serum concentrations of total thyroxine （T4）, total triiodothyronine （T3）, and thyroid-stimulating hormone （TSH） were compared between lithium-free and treated patients. Results Hypothyroidism rates of lithium-free patients were significantly lower than those of lithium-treated subjects （6.3% vs. 28.0%, P〈0.05; 10.8% vs. 32.1%, P〈0.05）. Significant changes in the three thyroid indices indicative of hypothyroidism was consistently associated with longer （〉 60 months） illness duration in lithium-free mania, whereas with greater severity of mania and more mood episodes in lithium-treated counterparts. There was also a significant positive correlation between serum TSH level and illness duration in lithium-free mania. Lithium-free depressed patients presented association of lower T4 levels with more episodes, whereas lithium-treated counterparts showed associations of lower T3 levels with the female sex and higher TSH levels with longer duration of illness. Conclusion Bipolar patient with and without lithium exposure differ in prevalence and association of hypothyroidism.