药物不良反应杂志
藥物不良反應雜誌
약물불량반응잡지
ADVERSE DRUG REACTIONS JOURNAL
2013年
4期
192-197
,共6页
李潇潇%梁军成%孙莉%郝伟%李静%邓艳萍
李瀟瀟%樑軍成%孫莉%郝偉%李靜%鄧豔萍
리소소%량군성%손리%학위%리정%산염평
阿片类依赖%康复%肝功能不全
阿片類依賴%康複%肝功能不全
아편류의뢰%강복%간공능불전
Opioid addict%Rehabilitation%Hepatic dysfunction
目的 探讨阿片类依赖者脱毒治疗结束后康复阶段内肝功能状况及其影响因素.方法 采用多中心临床试验方法,以上海市、四川省西昌市及河南省新乡市三地强制隔离戒毒所脱毒治疗结束后康复阶段的阿片类依赖者为研究对象,记录其人口学资料、药物滥用史和戒断症状.戒断症状采用稽延性戒断症状评定量表、汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)进行评估.检测研究对象入组时(脱毒治疗后第15天)、康复第4、12、18和24周末血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)及总胆红素(TBil)水平.结果 共130例处于康复阶段的阿片类依赖者纳入研究.其中男性106例(81.5％),女性24例(18.5％);平均年龄(43.8±15.3)岁.滥用毒品时间为1 ～ 242个月,平均(83.2±4.9)个月;脱毒治疗前l周毒品日用量为0.10 ～6.00 g,平均(1.02±0.09)g.入组时稽延性戒断症状评分为10 ～ 52分,平均(20.2±0.9)分,HAMA评分为4～41分,平均(13.7±0.6)分,HAMD评分为4～31分,平均(12.3±0.5)分.入组时受试者ALT、AST及TBil的异常率分别为22.3％(29例)、9.9％(8例)及2.3％(3例).第4周ALT异常率升至36.8％,与入组时比较,差异有统计学意义(P＜0.01).此后呈波动下降,第24周为16.7％,明显低于第4周(P＜0.01).第4周AST异常率也呈上升趋势,但其后随康复时间的延长波动性降低,第24周降至4.9％.康复第12周时TBil异常率为8.4％,明显高于入组时和第4周(均P＜0.05),之后迅速下降,第24周降至0.ALT发生有临床意义降低的例数由第4周的7例(5.6％)升至第24周的10例(16.7％),同期有临床意义升高的例数则由16例(12.8％)降至2例(3.3％).入组时稽延性戒断症状重症者发生ALT异常的风险为轻症者的0.907倍.24周康复期内女性出现ALT异常的风险是男性的4.51倍,抑郁倾向严重者是轻者的1.12倍.结论 阿片类依赖者脱毒治疗结束后康复初期肝功能可能出现异常性升高现象,随康复时间延长可逐步好转.对该类人群需持续监测肝功能指标,以便指导后续的康复及防复吸治疗.
目的 探討阿片類依賴者脫毒治療結束後康複階段內肝功能狀況及其影響因素.方法 採用多中心臨床試驗方法,以上海市、四川省西昌市及河南省新鄉市三地彊製隔離戒毒所脫毒治療結束後康複階段的阿片類依賴者為研究對象,記錄其人口學資料、藥物濫用史和戒斷癥狀.戒斷癥狀採用稽延性戒斷癥狀評定量錶、漢密頓焦慮量錶(HAMA)和漢密頓抑鬱量錶(HAMD)進行評估.檢測研究對象入組時(脫毒治療後第15天)、康複第4、12、18和24週末血清丙氨痠轉氨酶(ALT)、天鼕氨痠轉氨酶(AST)及總膽紅素(TBil)水平.結果 共130例處于康複階段的阿片類依賴者納入研究.其中男性106例(81.5％),女性24例(18.5％);平均年齡(43.8±15.3)歲.濫用毒品時間為1 ～ 242箇月,平均(83.2±4.9)箇月;脫毒治療前l週毒品日用量為0.10 ～6.00 g,平均(1.02±0.09)g.入組時稽延性戒斷癥狀評分為10 ～ 52分,平均(20.2±0.9)分,HAMA評分為4～41分,平均(13.7±0.6)分,HAMD評分為4～31分,平均(12.3±0.5)分.入組時受試者ALT、AST及TBil的異常率分彆為22.3％(29例)、9.9％(8例)及2.3％(3例).第4週ALT異常率升至36.8％,與入組時比較,差異有統計學意義(P＜0.01).此後呈波動下降,第24週為16.7％,明顯低于第4週(P＜0.01).第4週AST異常率也呈上升趨勢,但其後隨康複時間的延長波動性降低,第24週降至4.9％.康複第12週時TBil異常率為8.4％,明顯高于入組時和第4週(均P＜0.05),之後迅速下降,第24週降至0.ALT髮生有臨床意義降低的例數由第4週的7例(5.6％)升至第24週的10例(16.7％),同期有臨床意義升高的例數則由16例(12.8％)降至2例(3.3％).入組時稽延性戒斷癥狀重癥者髮生ALT異常的風險為輕癥者的0.907倍.24週康複期內女性齣現ALT異常的風險是男性的4.51倍,抑鬱傾嚮嚴重者是輕者的1.12倍.結論 阿片類依賴者脫毒治療結束後康複初期肝功能可能齣現異常性升高現象,隨康複時間延長可逐步好轉.對該類人群需持續鑑測肝功能指標,以便指導後續的康複及防複吸治療.
목적 탐토아편류의뢰자탈독치료결속후강복계단내간공능상황급기영향인소.방법 채용다중심림상시험방법,이상해시、사천성서창시급하남성신향시삼지강제격리계독소탈독치료결속후강복계단적아편류의뢰자위연구대상,기록기인구학자료、약물람용사화계단증상.계단증상채용계연성계단증상평정량표、한밀돈초필량표(HAMA)화한밀돈억욱량표(HAMD)진행평고.검측연구대상입조시(탈독치료후제15천)、강복제4、12、18화24주말혈청병안산전안매(ALT)、천동안산전안매(AST)급총담홍소(TBil)수평.결과 공130례처우강복계단적아편류의뢰자납입연구.기중남성106례(81.5％),녀성24례(18.5％);평균년령(43.8±15.3)세.람용독품시간위1 ～ 242개월,평균(83.2±4.9)개월;탈독치료전l주독품일용량위0.10 ～6.00 g,평균(1.02±0.09)g.입조시계연성계단증상평분위10 ～ 52분,평균(20.2±0.9)분,HAMA평분위4～41분,평균(13.7±0.6)분,HAMD평분위4～31분,평균(12.3±0.5)분.입조시수시자ALT、AST급TBil적이상솔분별위22.3％(29례)、9.9％(8례)급2.3％(3례).제4주ALT이상솔승지36.8％,여입조시비교,차이유통계학의의(P＜0.01).차후정파동하강,제24주위16.7％,명현저우제4주(P＜0.01).제4주AST이상솔야정상승추세,단기후수강복시간적연장파동성강저,제24주강지4.9％.강복제12주시TBil이상솔위8.4％,명현고우입조시화제4주(균P＜0.05),지후신속하강,제24주강지0.ALT발생유림상의의강저적례수유제4주적7례(5.6％)승지제24주적10례(16.7％),동기유림상의의승고적례수칙유16례(12.8％)강지2례(3.3％).입조시계연성계단증상중증자발생ALT이상적풍험위경증자적0.907배.24주강복기내녀성출현ALT이상적풍험시남성적4.51배,억욱경향엄중자시경자적1.12배.결론 아편류의뢰자탈독치료결속후강복초기간공능가능출현이상성승고현상,수강복시간연장가축보호전.대해류인군수지속감측간공능지표,이편지도후속적강복급방복흡치료.
Objective To investigate the hepatic function condition and influencing factors in opioid addicts during rehabilitation after detoxification.Methods Opioid addicts abstained from opioid in duration of rehabilitation were recruited from Shanghai,Sichuan and Henan Compulsory Isolated Detoxification Center.The subjects' demographics,drug abuse histories,and withdrawal symptoms were recorded.The protracted withdrawal symptoms scale,Hamilton Anxiety scale (HAMA),and Hamilton Depression scale (HAMD) were used to assess withdrawal symptoms.Hepatic function tests including alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBil) were performed at baseline (the 15th day after detoxification),4th,12th,18th,and 24th weeks of rehabilitation.Results A total of 130 subjects were enrolled into the study,comprising 106 (81.5％)male and 24 (18.5％) female with average age of (43.8 ± 15.3) years.Their duration of drug abuse was (83.2 ± 4.9) months ranging from 1 to 242 months and average daily dose taken during the last week before abstinence was (1.02 ± 0.09) g ranging from 0.10 to 6.00 g.At the beginning of rehabilitation,the protracted withdrawal symptoms scale averaged (20.2 ± 0.9) ranging from 10 to 52,HAMD averaged (13.7 ±0.6) ranging from 4 to 41,and HADA averaged (12.3 ± 0.5) ranging from 4 to 31.The initial percentage of abnormal ALT,AST,and TBil in the subjects were 22.3％ (29 cases),9.9％ (8 cases),and 2.3 ％ (3 cases),respectively.Compared with the baseline,the percentage of cases with abnormal ALT increased to 36.8％ at the 4th week of rehabilitation (P ＜ 0.01) and then fluctuated and dropped to 16.7％at the 24th week.The change between the 4th and the 24th weeks was statistically significant (P ＜ 0.01).The percentage of cases with abnormal AST showed a trend of increase at the 4th week and then fluctuated and reduced to 4.9％ at the 24th week.The percentage of cases with abnormal TBil at the 12th week was 8.4％,which was much higher than that at the baseline and the 4th week of rehabilitation (all P ＜ 0.05),and rapidly decreased to zero at the 24th week.The number of subjects who had clinically significant decrease in ALT levels increased from 7 cases (5.6％) at the 4th week to 10 cases (16.7％) at the 24th week,while the number of subjects who had clinically significant increase in ALT levels was decreased from 16 cases (12.8％) to 2 cases (3.3％) at the same time.The risk for abnormal ALT levels in the patients with graver withdrawal symptoms at the beginning of rehabilitation was 0.907 times higher than that with lighter withdrawal symptoms.The risk of abnormal ALT levels in the female patients was 4.51 times higher than that in the male patients.The risk of abnormal ALT levels in patients with severe depression was 1.12 times higher than that with lighter depression during 24 weeks of rehabilitation (OR were 4.51 and 1.12,respectively).Conclusions The levels of hepatic function parameters in opioid addicts may be abnormally increased during initial rehabilitation and may improve gradually with prolongation of rehabilitation.Continuous monitoring of hepatic function of opioid addicts should be performed and it is a good strategy for both rehabilitation and prevention of relapse.
