CAJ | 학술논문

背景：西方国家的研究持续报道海洛因成瘾者共患反社会人格障碍（Anitsocial Personality Disorder，ASPD）的比率很高，但中国海洛因成瘾者共患ASPD的报道比率变异很大，可能是因为中国的临床医生在治疗物质滥用问题时没有考虑人格问题。这份报告对评估中国海洛因依赖患者共患ASPD比率的研究做了系统分析。方法：我们检索了中国数据库（中国知网，万方数据知识服务平台，台湾电子期刊服务网）和西方数据库（PubMed和EMBASE）的相关研究。两位作者独立检索文献，确定符合预定纳入和排除标准的文献，评价纳入研究的文献质量，并提取用于分析的数据。使用StatsDirect 3.0进行统计分析。 　　结果：检索到15项符合条件的研究，共有3692例海洛因依赖患者。其中仅有2项高质量研究。所有的研究都是在康复中心或医院进行的。在这些患者中合并ASPD终生患病率为30％（95％CI：23~38％），但这些研究结果的异质性很大（I2=95％，p<0.001）。 　　男性患者的患病率显著高于女性（44％比21％），注射吸毒患者的患病率显著高于烫吸的患者（44％比27％）。研究方法较严谨的报道的海洛因依赖者ASPD患病率较高。 　　结论：虽然现有的有关中国接受治疗的海洛因依赖患者共患ASPD的文献存在较大的方法学问题，但据我们的分析，估计这些患者中大约有三分之一的人是符合ASPD诊断标准的。进一步需要开展的工作是提高临床医生对这一问题的认识，比较伴ASPD患者与不伴ASPD患者的发病机制、治疗效果和复吸情况，制定出适合这个治疗相对困难的海洛因依赖患者亚群的针对性的干预措施并加以验证。
배경：서방국가적연구지속보도해락인성은자공환반사회인격장애（Anitsocial Personality Disorder，ASPD）적비솔흔고，단중국해락인성은자공환ASPD적보도비솔변이흔대，가능시인위중국적림상의생재치료물질람용문제시몰유고필인격문제。저빈보고대평고중국해락인의뢰환자공환ASPD비솔적연구주료계통분석。방법：아문검색료중국수거고（중국지망，만방수거지식복무평태，태만전자기간복무망）화서방수거고（PubMed화EMBASE）적상관연구。량위작자독립검색문헌，학정부합예정납입화배제표준적문헌，평개납입연구적문헌질량，병제취용우분석적수거。사용StatsDirect 3.0진행통계분석。 　　결과：검색도15항부합조건적연구，공유3692례해락인의뢰환자。기중부유2항고질량연구。소유적연구도시재강복중심혹의원진행적。재저사환자중합병ASPD종생환병솔위30％（95％CI：23~38％），단저사연구결과적이질성흔대（I2=95％，p<0.001）。 　　남성환자적환병솔현저고우녀성（44％비21％），주사흡독환자적환병솔현저고우탕흡적환자（44％비27％）。연구방법교엄근적보도적해락인의뢰자ASPD환병솔교고。 　　결론：수연현유적유관중국접수치료적해락인의뢰환자공환ASPD적문헌존재교대적방법학문제，단거아문적분석，고계저사환자중대약유삼분지일적인시부합ASPD진단표준적。진일보수요개전적공작시제고림상의생대저일문제적인식，비교반ASPD환자여불반ASPD환자적발병궤제、치료효과화복흡정황，제정출괄합저개치료상대곤난적해락인의뢰환자아군적침대성적간예조시병가이험증。
Background:Studies from Western countries consistently report very high rates of comorbid Antisocial Personality Disorder (ASPD) among individuals with heroin addiction, but the reported proportion of Chinese individuals with heroin addiciton who have co-morbid ASPD varies widely, possibly because Chinese clinicians do not consider personality issues when treaitng substance abuse problems. Aim:Conduct a meta-analysis of studies that assessed the proporiton of Chinese individuals with heroin dependence who have comorbid ASPD. Methods:We searched for relevant studies in both Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Taiwan Electronic Periodical Services) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently retrieved the literature, identified studies that met pre-defined inclusion and exclusion criteria, assessed the quality of included studies, and extracted the data used in the analysis. Staitsitcal analysis was performed using StatsDirect 3.0 and R sotfware. Results:The search yielded 15 eligible studies with a total of 3692 individuals with heroin dependence. Only 2 of the studies were rated as high-quality studies. All studies were conducted in rehabilitaiton centers or hospitals. The pooled lifeitme prevalence of ASPD in these subjects was 30%(95%CI:23%-38%), but the heterogeneity of results across studies was great (I2=95%, p<0.001). Men had a higher prevalence than women (44%vs. 21%), and injeciton heroin users had higher prevalence than those who smoked heroin (44%vs. 27%). Studies that were methodologically stronger had higher reported prevalence of ASPD among heroin dependent individuals. Conclusions There are substantial methodological problems in the available literature about ASPD in Chinese individuals receiving treatment for heroin dependence, but we estimate that about one-third of them meet criteria for ASPD. Further work is needed to increase clinicians’ awareness of this issue;to compare the pathogenesis, treatment responsiveness and recidivism of those with and without ASPD;and to develop and test targeted interventions for this difficult-to-treat subgroup of individuals with heroin dependence.