Tevfik KALELİOĞLU, Akif TAŞDEMİR, Abdullah GENÇ, Esra Sena GENÇ, İsmail ÖZVER, Dilek YEŞİLBAŞ, Kürşat ALTINBAŞ, Erhan KURT

Lityum Tekli Tedavisi Alan Hastaların Hematolojik ve Biyokimyasal Değerlerinin İncelenmesi

Amaç: Tedavi edici dozlarda uzun dönem lityum (Li) tedavisinin değişik organ ve sistemler üzerinde belirgin toksik etkiler oluşturabileceği üzerinde durulmaktadır. Lityum tekli tedavisi altındaki ötimik iki uçlu bozukluk hastalarında lityumun karaciğer, böbrek, tiroid işlevleri ve hematopoetik sisteme etkisinin geriye dönük araştırılması amaçlanmıştır. Yöntem: Hastaların Ocak 2009’dan Ocak 2011 tarihine kadarki tıbbi dosya verileri tarandı. Karaciğer, böbrek, tiroid fonksiyon testleri sonuçları ve tam kan sayımına ait bilgiler kaydedildi. En az üç aydır lityum tekli tedavisi kullanan hasta dosyalarının verileri çalışmaya alındı. Bulgular: 65 hasta çalışmaya dahil edildi. Hastaların %41.5’i (n=27) erkek, %58.5’i (n=38) kadın ve bütün hastalar İki uçlu Bozukluk Tip I idi. Hastaların yaş ortalaması 40.47±11.41 idi. Hastaların hastalık süreleri 16.70±9.86 yıl ve kullandığı ortalama lityum dozu 1160±274 mg/gün ve kullanma süresi 156.29±117.53 hafta (min: 12, max: 410). Kreatinin, ürik asit ve albümin değerlerinde (sırasıyla; p < 0.001, p < 0.001 ve p=0.034) ve hemoglobin, hematokrit ve MPV değerlerinde cinsiyetler arasında anlamlı fark mevcuttu (sırasıyla; p < 0.001, p < 0.001, p=0.019). Hastaların %47.7’sinde nötrofil yüksekliği, %4.6’sında trombositopeni ve %4.6’sında trombositozis saptandı. Kadın ve erkekler arasında ortalama sT3 (p=0.173), sT4 (p=0.167) ve TSH (p=0.170) açısından istatistiksel olarak anlamlı bir fark bulunmadı. Sonuç: Uzun dönem lityum tekli tedavisi alan iki uçlu bozukluk hastalarında ortalama böbrek ve karaciğer işlevlerinin genel olarak normal sınırlarda seyrettiği ancak bazı kişilerde farklılıklar olabileceği gözlenmiştir. Lityum tekli tedavisinin farklı organ ve sistemler üzerindeki yan etkileri literatür bilgileriyle uyumluydu.

Anahtar Kelimeler:

lityum tekli tedavi, metabolik parametreler, tiroid, hematolojik sistem

The review of hematologic and other biochemical parameters in lithium monotherapy patients

Aims: Long term treatment with lithium has been suggested to cause prominent toxic effects on different organs and systems. We aimed to investigate the effect of lithium on liver, kidney, and thyroid functions and hematopoietic system in euthymic patients with bipolar mood disorder, who have been on lithium monotherapy. Methods: The medical charts of the bipolar patients from January 2009 to January 2011 were screened. Liver, kidney, and thyroid function test results and complete blood count parameters were recorded. The data of patients, who were under lithium monotherapy for three months or longer, were included in the study. Results: A total of sixty five patients were included in this study and 41.5% of the patients (n=27) were male and 58.5% (n=38) were female. All patients were diagnosed with Type I Bipolar Disorder. The mean age of the patients was 40.47±11.41; 41.84±12.49 years for females versus 38.88±9.61 years for males (p=0.313). The mean duration of illness was 16.70±9.86 years and the received mean lithium dose was 1160±274 mg/day. The duration of lithium therapy was 156.29±117.53 weeks (min: 12 max: 410); 139.26±130.20 weeks in males and 168.39±107.80 weeks in females (p=0.207). There were significant differences between genders for creatinine, uric acid, and creatinine levels (p<0.001, p<0.001, and p=0.034, respectively) and for hemoglobin, hematocrit, and MPV values (p<0.001, p<0.001, p=0.019, respectively). Hematocrit values of the 13,8% of women were below the reference range, however hematocrit values of male patients were between reference range (?2=7.422, p=0.006). There were higher neutrophil levels in 47.7% of patients, thrombocytopenia in the 4.6% of patients, and thrombocytosis in the 4.6% of patients. There were no significant differences between gender according to average values of fT3 (p=0.173), fT4 (p=0.167), and TSH (p=0.170). Conclusion: Kidney and liver functions in patients with bipolar mood disorder, who have been on long term lithium monotherapy generally seemed to be in reference range, however some differences were observed in some patients. The side effects of lithium monotherapy on the different organs or systems were similar to reported findings in the literature.

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