双相障碍患者高尿酸血症发生率与精神药物及血药浓度的关系

Incidence of hyperuricemia in patients with bipolar disorder and its relationship with psychotropic drugs and drug concentrations

目的探讨双相障碍(bipolar disorder,BD)患者高尿酸血症(hyperuricemia,HUA)的发生率及其与精神药物、血药浓度的关系。方法回顾性纳入2252例BD患者,根据血清尿酸(uric acid,UA)水平分为HUA组和非高尿酸血症(non-hyperuricemia,NHUA)组,比较两组的人口学特征、临床特征和用药差异,分析血清UA水平与精神药物及血药浓度的关系。结果BD患者中HUA的发生率为42.94%(967例)。偏相关分析显示出院时UA水平与血锂浓度呈正相关(r=0.321,P=0.026),与丙戊酸浓度(r=-0.046,P=0.758)、奥氮平浓度(r=0.046,P=0.756)无统计学相关性。多因素线性回归显示,出院时UA水平与使用碳酸锂(β=0.130,P<0.001)、丙戊酸盐(β=0.057,P=0.001)和奥氮平(β=0.039,P=0.028)呈正相关,与使用拉莫三嗪(β=-0.034,P=0.039)呈负相关,模型的解释程度为47%(F=117.908,P<0.001)。结论BD患者HUA高发,使用碳酸锂、丙戊酸盐、奥氮平可能为其危险因素,拉莫三嗪可能为保护因素。

Objective This study aims to investigate the incidence of hyperuricemia(HUA)in patients with bipolar disorder(BD)and its relationship with psychotropic drugs and drug concentrations.Methods Two thousand two hundred and fifty-two patients with BD were included and divided into HUA group and non-hyperuricemia group(NHUA)according to the level of serum uric acid(UA).The demographic,and clinical characteristics as well as medication differences between the two groups were compared.The relationship between serum UA level and psychotropic drugs and plasma drug concentration was analyzed.Results The incidence of HU A in BD patients was 42.94%.Partial correlation analysis showed that the level of serum UA at discharge was positively correlated with the concentration of lithium(r=0.321,P=0.026),but not with the concentration of valproic acid(r=-0.046,P=0.758)and olanzapine(r=0.046,P=0.756).Multivariate linear regression showed that the level of serum UA at discharge was positively correlated with the use of lithium carbonate(β=0.130,P<0.001),valproate(β=0.057,P=0.001)and olanzapine(β=0.039,P=0.028),while was negatively correlated with the use of lamotrigine(β=-0.034,P=0.039).The interpretation degree of the model was 47%(F=117.908,P<0.001).Conclusion Patients with BD have high incidence of HU A.Lithium carbonate,valproate and olanzapine may be risk factors of HU A,while lamotrigine may be a protective factor.