海洛因成瘾和海洛因成瘾者的治疗

近年来在国际毒潮的影响下，我国的毒品问题越来越严重，吸毒人数连年呈直线上升趋势，其中主要的是海洛因吸毒者。因此了解海洛因成瘾的原因和海洛因成瘾者的戒毒治疗对预防吸毒，挽救吸毒者、控制吸毒问题的发展是十分重要的。海洛因，学名二乙酰吗啡，是由吗啡乙酰化而...     

药物依赖临床治疗的研究新进展

随着吸毒人员的剧增,药物依赖极大的危害着人类健康和社会稳定,已经成为目前严重的社会性问题。心瘾是患者复吸的重要原因,心瘾的戒断是治疗成瘾的关键。供临床医生选择的治疗方法有很多,但是根据成瘾者的病情合理的选择治疗措施是目前临床工作中面临的巨大挑战。本文综述了目前物质依赖的药物治疗的作用机制以及临床疗效、各种手术戒毒的效果以及不良反应、心理行为治疗的原因以及具体措施,药物治疗、手术治疗以及中西医联合治疗的最新进展。     

吸毒对人类生态的影响

吸毒对人类生态的影响谈绍强,刘超英（广州市槎头戒毒中心）吸毒在医学上称为＂药物依赖＂,国际上通用术语为＂药物滥用＂,６０年代以来,吸食毒品先在西方国家出现,进而在世界范围内广泛流行。时至今日吸毒已成为当今全球的一大公共卫生问题和面临的严重社会问题,成...     

儿茶酚胺类激素在海洛因成瘾中的作用

目的：探索儿茶酚胺类激素在海洛因成瘾中的作用。方法：肌肉注射利血平后再给予海洛因,用放射免疫法检测血液和脑组织中多巴胺（dopamine,DA）、环磷酸腺苷（cMAP）、环磷酸鸟苷（cMGP）水平。结果：利血平组大鼠未出现明显的戒断反应症状。放射免疫法检测发现,血液、中脑腹侧背盖区（ventral tegmental area,VTA）、大脑前额叶皮（prefrontal cortex,PFC）、海马（hippocampus,Hipp）中cAMP水平：利血平纽比对照组和海洛因组分别升高35．36％和15．53％、24．08％和8．53％、15．66％和8．13％、21．95％和8．40％;PFC、Hipp、纹状体（striatum）、伏隔核（nueleus aceumbens,NAc）中DA水平：利血平组比对照组和海洛因组分别降低74．09％和82．86％、81．06％和82．23％、91．62％和86．55％、84．35％和90．63％;脑组织cGMP的含量均低于对照组。神经电生理检测发现,海洛因和利血平组,大鼠的脑电图、心电图和肌梭放电图与对照组比,均发生明显的改变。结论：儿茶酚胺类激素是引起海洛因成瘾的关键因素。     

药物滥用者红细胞免疫功能的变化

通过检测红细胞C3b受体花环（RBC－C3bRR)、红细胞免疫复合物光环（RBC－ICR）、粘附增强因子活性（RFER）及抑制因子活性（RFIR）,观察了50例海洛因依赖者红细胞免疫功能的变化。结果表明,海洛因依赖者RBC－C3bRR、RFER明显下降（P＜0．01）,而RBC-ICR、RFIR则明显升高（P＜0．01）。本文对检测结果进行了初步探讨。     

呼吸道过敏性疾病与社会心理因素双向关系的Meta分析

目的：系统评价呼吸道过敏性疾病和社会心理因素的关系。方法：计算机检索Cochrance图书馆、Medline、EMbase、Pubmed、CBM、CNKI等数据库,查找包括心理社会因素对呼吸道过敏性疾病的影响或者呼吸道过敏性疾病对精神健康影响的临床研究。根据纳入和排除标准选择文献,对符合纳入标准的文献进行Meta分析,计算其合并OR值及95％CI。结果：共纳入20个病例研究（13篇文献）,其中13个研究评估心理社会因素对呼吸道过敏性疾病的影响,7个研究评估效果呼吸道过敏性疾病对心理健康的影响。在这些研究中呼吸道过敏性疾病是评估哮喘和过敏性鼻炎。Meta分析结果显示社会心理因素和呼吸道疾病的发生发展有关[OR=1．77,95％CI（1．42,2．22）],呼吸道过敏性疾病与未来不健康的心理发生发展有关[OR=1．73,95％CI（1．47,2．03）]。结论：当前的研究发现呼吸道过敏性疾病和社会心理因素有很大的关系。这支持在呼吸道过敏性疾病治疗除了传统的生理和药理干预外,心理干预呼吸道对过敏性疾病的预防和管理也发挥作用。     

药物复吸的神经生物学机制

复吸是指药物依赖者在戒药一段时间后,由于某些因素的激发,重现觅药和用药的行为。是药物成瘾的重要特征,与多种因素有关,其神经生物学机理十分复杂。杏仁核复合体、前额叶皮层、海马以及伏隔核等结构在复吸的过程中起重要的作用,多巴胺和谷氨酸等神经递质及其受体与复吸有关。该文介绍了复吸的神经生物学机制。     

针刺治疗药物成瘾的研究进展

近35年来,针刺治疗物质依赖的研究引起了越来越多的国内外相关学者和临床医生的关注.该领域内的研究进展大致可以分为三个主要阶段:(一)香港的温祥来医师于1973年首次报道,采用电针(两对体针和一对耳针连接电刺激)可以减轻阿片成瘾者的戒断症状(身体依赖);(二)纽约M.Smith医师(1985)领导的美国国家针刺脱毒协会(NADA)确定,仅采用耳针,不加电刺激,治疗药物依赖(身体依赖);(三)北京大学神经科学研究所(PKU NRI)韩济生教授及其同事(1992-)用特定频率的躯体穴位电刺激缓解海洛因成瘾者的戒断症状(身体依赖),并可抑制患者脱毒后对毒品的心理渴求(精神依赖)以预防复吸.本文将综述针刺干预药物依赖的临床疗效、实验研究及初步作用机制.     

韩氏针刺对海洛因依赖大鼠学习记忆及海马SYP表达的影响

目的：初步探讨韩氏针刺对海洛因依赖大鼠学习记忆的影响及其作用机制。方法：按逐日递增的原则皮下注射海洛因建立成瘾模型,利用Morris水迷宫测定大鼠成瘾后及针刺治疗后大鼠学习记忆的变化,免疫组化测定记忆相关蛋白突触素（SYP）在海马的表达。结果：①Morris水迷宫定位航行实验中,成瘾组逃避潜伏期较对照组明显延长（P〈0.05）,而针刺组较成瘾组明显缩短（P〈0.05）;空间探索实验中,成瘾组在第4象限搜索时间及第4象限游泳距离占总距离的百分比较对照组明显下降（P〈0．05）;而针刺组较成瘾组明显增加（P〈0．05）。②海马组织中SYP的表达成瘾组低于对照组（P〈0.05）,而针刺组明显高于成瘾组（P〈0．05）。结论：韩氏针刺戒断治疗可以部分恢复由于海洛因依赖导致的大鼠学习记忆能力的减退,增加海马内SYP表达。     

喉癌患者合并抑郁症影响因素分析及对策

目的：探讨喉癌患者抑郁情绪的现状及其主要影响因素,并提出相应的护理对策。方法：采用抑郁自评量表（sos）、社会支持评定量表（SSRS）以及自行设计问卷,对96例经治的喉癌患者进行现况调查。采用SPSS13．0软件进行单因素和多因素累积logistic回归分析。结果：本研究实际有效测评96例患者,发现抑郁者54例,占56．25％;本组患者SDS为（37．59：1：8．74）分,与全国常模SDS（33．46±8．55,n=1340）相比,差异有统计学意义（P〈0．05）;单因素和多因素累积logistic回归表明性别、文化程度、医疗费用来源、病程、治疗方案及社会支持度与无抑郁症患者相比差异有显著性意义（P〈0．05）。结论：喉癌患者抑郁情绪比较严重,护理人员应采取针对性的护理对策,提高患者的心理健康水平,促进躯体疾病康复。     

Serum concentrations of macro and trace elements in heroin addicts of the Canary islands

Na, K, Ca, Mg, P, Fe, Cu, Zn and Se concentrations were determined in the serum of 106 heroin addicts and were compared with the concentrations obtained in a control group formed of 186 apparently healthy individuals. Heroin addicts displayed K and Se mean concentrations lower (p < 0.05), and Na, Mg, P mean concentrations and a Cu/Zn ratio higher (p < 0.05) than those mean values observed in the control group. The Mg and P concentrations in the serum of heroin addicts tended to normalize when age increased. The heroin addicts included in the methadone maintenance treatment program had higher serum mean concentrations of K and Mg than the heroin addicts in the detoxification process. The Na, K and Mg concentrations displayed highly significant correlations, with a different behavior for the heroin addicts group and the control group. When applying factor analysis and representing the scores of the first and second factors, the heroin addicts tended to differentiation from the control group. However, methadone substitution treatment was not able to normalize these concentrations.     

HCV and HIV Infection among Heroin Addicts in Methadone Maintenance Treatment (MMT) and Not in MMT in Changsha and Wuhan,China

Objective

To compare HCV and HIV infection among heroin addicts in MMT and not in MMT in two large cities in central China.

Methods

A total of 541 heroin addicts were recruited from MMT clinics and voluntary detoxification centers in Changsha and Wuhan, China. Structured questionnaires collected data on their socio-demographics, clinical status, risk behaviors, and their knowledge of HIV. Their HIV serostatus and Hepatitis C virus (HCV) serostatus were determined by testing antibodies in blood serum.

Results

We observed a higher prevalence of HCV infection among MMT heroin addicts (82.3%) than that in the non-MMT group (50.6%). However, our findings indicated that the heroin addicts in MMT had less drug or sexual HIV/HCV risk behaviors and more knowledge about HIV than non-MMT addicts. The heroin addicts in MMT had a significantly higher percentage of individuals who always used condoms (44.9%) compared with patients in the non-MMT group (14.6%, p = 0.039), and they had more knowledge about HIV than non-MMT individuals (p<.001). The percentage of HIV-positive addicts in the MMT group (0.7%) and non-MMT group (0.8%) were almost same.

Conclusion

Our study indicated that the rate of HCV infection among heroin addicts among MMT or non-MMT settings in central China is very high. The non-MMT heroin addicts have higher risk of becoming infected with HCV in the future, while at present they have lower rates of HCV infection than MMT heroin addicts. Although rates of HIV infection among MMT and non-MMT heroin addicts are low now, they are all at great risk of becoming infected with HIV in the future, especially for non-MMT heroin addicts. We should use the MMT sites as a platform to improve the control of HCV and HIV infection in heroin addicts.     

The Use of Propoxyphene Napsylate in the Treatment of Heroin and Methadone Addiction

The use of methadone in the treatment of heroin addiction continues to be controversial. Propoxyphene napsylate (Darvon N®) is a possible alternative and a pilot study was conducted to test its acceptability, safety and clinical efficacy in treating long term, “multi-relapse” heroin addicts.Findings indicate that propoxyphene napsylate suppresses many of the symptoms associated with opioid withdrawal phenomena. It should be viewed as a very promising therapeutic tool to be used in conjunction with psychological counseling and socio-vocational rehabilitation in detoxification and maintenance therapy for heroin or methadone addiction.     

T-helper 1 and 2 serum cytokine assay in chronic opioid addicts

There are a few studies with conflicting results on the effects of opioids on the functioning of immune system. This study was performed to investigate the in vitro production of interferon-gamma and interleukin-10 after antigenic stimulation of cells using whole blood from opioid addicts. Blood samples were taken from 20 chronically opioid-addicted persons, who voluntarily enrolled for detoxification (10 opium and 10 heroin addicts). Blood samples were also taken from 10 healthy individuals with no history of drug abuse as the control. Cell culture was performed in a whole blood culture assay. Diluted blood samples were stimulated with phytohemagglutinin or with lipopolysaccharide and the supernatants were collected to measure cytokine production. The results demonstrated a significant decrease in interferon-gamma production and an increase in interleukin-10 secretion in heroin addicts, relative to the control group (35.9+/-26.3 versus 110.2+/-60.3 pg/mL, p<0.01 and 71.8+/-28.4 versus 17.1+/-13.5 pg/mL, p<0.01, respectively), however the changes in these values in opium addicts were not significant compared to healthy individuals. The results could suggest that opioid addiction leads to a shift in the Th1/Th2 cytokine balance of peripheral CD4+ cells towards the Th2 response, and opioid addicts demonstrate reduced mitogenic responsiveness of lymphocytes relative to healthy individuals.     

Clonidine improved laboratory-measured decision-making performance in abstinent heroin addicts

Background

Impulsivity refers to a wide spectrum of actions characterized by quick and nonplanned reactions to external and internal stimuli, without taking into account the possible negative consequences for the individual or others, and decision-making is one of the biologically dissociated impulsive behaviors. Changes in impulsivity may be associated with norepinephrine. Various populations of drug addicts all performed impulsive decision making, which is a key risk factor in drug dependence and relapse. The present study investigated the effects of clonidine, which decreased norepinephrine release through presynaptic alpha-2 receptor activation, on the impaired decision-making performance in abstinent heroin addicts.

Methodology/Principal Findings

Decision-making performance was assessed using the original version of Iowa Gambling Task (IGT). Both heroin addicts and normal controls were randomly assigned to three groups receiving clonidine, 0, 75 µg or 150 µg orally under double blind conditions. Psychiatric symptoms, including anxiety, depression and impulsivity, were rated on standardized scales. Heroin addicts reported higher scores on the Barratt Impulsiveness Scale and exhibited impaired decision-making on the IGT. A single high-dose of clonidine improved the decision-making performance in heroin addicts.

Conclusions/Significance

Our results suggest clonidine may have a potential therapeutic role in heroin addicts by improving the impaired impulsive decision-making. The current findings have important implications for behavioral and pharmacological interventions targeting decision-making in heroin addiction.     

Characteristics of hepatitis C infection in injecting drug users in Zadar County, Croatia

The aim of the study was to determine additional risk factors that could increase the prevalence of hepatitis C (HCV) infection among injecting drug users (IDU). The study included 327 heroin addicts registered in Zadar County, Croatia. The participants were divided into two groups according to their HCV status. HCV-positive and HCV-negative study participants were compared. HCV-positive group started injecting heroin at earlier age (median 18.5 years) than HCV-negative group (median 20.0 years) (p = 0.032) and had been injecting heroin for a significantly longer period (median 5 years vs. median 4 years, respectively; p < 0.001). IDUs in HCV-positive group shared their injecting equipment significantly more often than IDUs in HCV-negative group (p < 0.001; chi2 = 32.7). The main reasons for starting drugs were curiosity, psychological reasons (depression and/or neurosis), and peer or partner pressure in HCV-positive group, and fun, curiosity, and peer pressure in HCV-negative group (p = 0.051; chi2 = 23.6). Earlier onset of heroin use, longer heroin use, sharing injection equipment, curiosity, and psychological problems as reasons for starting drugs were associated with higher prevalence of HCV infection among injecting heroin users in Zadar County.     

The personality traits and social characteristics of Croatian heroin addicts and cannabis users

The purpose of this study was to investigate differences in social characteristics (level of education, working and family status, and criminal record) between heroin addicts, cannabis users and a control group. Additional goal was to explore the possibility of discerning subjects of different addiction status (of both gender) based on their scores on Eysenck Personality Questionnaire (EPQ). In comparison to the control group, heroin addicts and cannabis users had lower level of education, were more frequently unemployed and with criminal record, and more often came from dysfunctional families. In cannabis users the frequency of these characteristics was generally lower than in heroin addicts. Proportion of correct classification of subjects in groups of different addiction status based on the EPQ scores was 23.3% for males (higher than by chance alone), and 30% for females.