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。     

多巴胺D2受体基因多态性位点与海洛因依赖的关系

目的:探讨多巴胺D2受体(Dopamine D2 receptors,DRD2)基因3'非翻译区Taq ⅠA、启动子区-141 Ins/Del 2个多态性位点和海洛因依赖的相关性.方法:采用聚合酶链反应-限制性片段长度多态(PCR-RFLP)技术检测320例海洛因依赖患者及300例健康对照组的TaqⅠA和-141 Ins/Del2个多态性位点的基因型.采用HaploView4.0及SPSS11.5软件分析这2个多态性位点的基因型、等位基因频率及组间差异.结果:DRD2基因Taq ⅠA位点的基因型及等位基因频率分布在海洛因依赖组与正常对照组存在显著性差异(p<0.01),海洛因依赖组TaqⅠA位点的等位基因A1频率显著高于正常对照组(x2=11.156,p=0.001,OR=1.463,95%CI=1.170～1.830);DRD2基因-141 Ins/Del位点的基因型及等位基因频率分布在海洛因依赖组与正常对照组之间无统计学差异(p<0.05).结论:DRD2基因TaqⅠA位点多态性可能与海洛因依赖有关,携带有TaqⅠA多态性位点A1等位基因的个体可能更容易对海洛因产生依赖.     

强啡肽原基因3'非翻译区多态性位点与海洛因依赖的关联研究

目的:探讨强啡肽原(prodynorphin,PDYN)基因3'非翻译区的3个单核苷酸多态性(Single Nucleotide Polymorphism,SNP)位点与海洛因依赖的相关性.方法:严格按照诊断标准,选取无亲缘关系的海洛因依赖患者212例,健康对照200例提取基因组DNA,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测PDYN基因3'非翻译区rs1022563、rs2235749、rs9100803个多态性位点的基因型,采用HaploView及SPSS11.5软件分析各位点基因型、等位基因频率及组间差异.结果:PDYN基因rs2235749的基因型及等位基因频率分布在海洛因依赖组与正常对照组存在显著性差异(p＜0.01),在海洛因依赖组中等位基因A的频率显著高于正常对照组(p＜0.01).连锁不平衡结果显示,这3个SNPs位点不连锁,D'=0.215.结论:PDYN基因3'非翻译区rs2235749与海洛因相关联,携带有等位基因A的个体可能对海洛因更容易产生依赖.     

CNR1、GAD1和BDNF基因多态性与云南傣族男性海洛因依赖的相关性分析

为了探讨大麻素受体1基因(Cannabinoid receptor 1,CNR1)3个SNP位点(rs6454674、rs1049353和rs806368)、谷氨酸脱羧酶1基因(Glutamate decarboxylase 1,GAD1)3个SNP位点(rs1978340、rs3791878和rs11542313)、脑源性神经营养因子基因(Brain-derived neurotrophic factor,BDNF)2个SNP位点(rs6265和rs13306221)与云南傣族男性海洛因依赖的相关性,文章采用病例对照关联分析,建立8-SNPs复合扩增体系,应用SNaPshot方法检测165例傣族男性海洛因依赖患者和170例健康傣族男性CNR1、GAD1和BDNF基因8个SNPs位点基因型,采用SPSS17.0、Haploview4.2、PHASE2.1和MDR软件进行统计学分析。结果显示,rs13306221基因型频率在海洛因依赖组和对照组中的差异具有统计学意义(P<0.025),海洛因依赖组rs6265 A等位基因显著高于对照组(P<0.05),由rs1978340-rs3791878-rs11542313构建的T-A-C、C-C-C、C-C-T和T-C-C单体型及rs6265-rs13306221构建的A-G单体型频率在海洛因依赖组及对照组中差异具有统计学意义(P<0.05),海洛因依赖组T-A-C、C-C-T和A-G单体型频率明显高于对照组,GAD1基因rs1978340与rs3791878之间可能存在强协同的交互作用。结果表明,CNR1基因rs1049353多态性、GAD1基因rs1978340和rs11542313多态性以及BDNF基因rs6265和rs13306221多态性与云南傣族男性海洛因依赖相关联,并且携带rs6265 A等位基因的个体可能更容易对海洛因产生依赖。     

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。     

两种复吸动物模型的神经生物学机制

复吸是指撤药一段时间后,觅药和用药行为的恢复。它是药物成瘾的主要特征之一,也是药物成瘾治疗亟待解决的头号难题。本文介绍两种复吸动物模型——自身给药消退恢复模型、条件性位置偏爱消退复燃模型建立的方法,对模型的效标效度进行评价,探讨复吸的神经生物学机制,为药物成瘾的治疗提供研究思路。     

精神分裂症患者住院依赖原因分析与护理干预

长期住院的精神分裂症患者在渡过急性期后,有较多病人会有一些残余症状及受损的社会功能[1]。病人逐步走向衰退,对外界刺激反应能力降低,丧失了回归社会的能力和欲望,并且随着病程及年龄的增长越来越严重,出现了住院依赖现象。为探讨慢性精神分裂症患者住院依赖的相关因素,寻求有效的护理方法,现对77例慢性精神分裂症患者进行临床分析如下。     

多巴胺D4受体基因启动子区功能多态性与海洛因依赖的相关性研究

目的:探讨多巴胺D4受体(DRD4)基因启动子区的3个功能多态性位点与海洛因依赖的相关性.方法:严格按照诊断标准,选取无亲缘关系的海洛因依赖患者212例及健康对照组200例提取基因组DNA,采用聚合酶链反应及等位基因特异性扩增技术检测DRD4基因启动子区-521C/T、-616C/G、及-1240L/S 3个功能多态性位点的基因型,采用HaploView及SPSS11.5软件分析各位点基因型、等位基因频率及组间差异.结果:DRD4基因-521C/T的基因型及等位基因频率分布在海洛因依赖组与正常对照组存在显著性差异(p＜0.05).结论:多巴胺D4受体(DRD4)基因-521C/T多态性与海洛因依赖相关联,T等位基因可能是海洛因依赖的风险因子.     

SLC6A4基因多态性与海洛因依赖的关联性研究

目的:探讨5-羟色胺转运体基因(solute carrier family 6 member 4,SLC6A4)基因4个单核苷酸多态性(single nucleotide polymorphism,SNP)位点与海洛因依赖之间的关系。方法:严格按照诊断标准,选取无亲缘关系的海洛因依赖个体397例(病例组)及健康对照个体402例(对照组)提取基因组DNA,采用SNaPshot SNP分型技术对SLC6A4基因4个SNP位点(rs1042173,rs3813034,rs6354,rs7224199)进行基因分型,比较病例-对照组间各位点等位基因、基因型频率的差异。结果:病例组和对照组SLC6A4基因rs1042173和rs3813034位点的基因型和等位基因频率比较存在显著性差异(P0.05),rs1042173的C等位基因(P=0.031,OR=1.317,95%CI=1.026-1.691)及rs3813034的C等位基因(P=0.013,OR=1.375,95%CI=1.069-1.768)是海洛因依赖的危险因素。病例组TCC单倍型(rs7224199、rs3813034和rs1042173)的比例较对照组显著增高(P0.05)。结论:SLC6A4基因rs1042173和rs3813034多态性可能与海洛因成瘾有关,携带有rs1042173的C等位基因和rs3813034的C等位基因的个体及携带TCC单倍型的个体可能更容易对海洛因产生依赖。     

5-羟色胺受体基因多态性位点与海洛因依赖的关联性研究

目的：5-HT（5-hydroxytryptamine,5-HT）参与了多种中枢神经活动的生理过程,其功能异常可以影响很多行为障碍,已有研究显示,5-HT水平与多种精神疾病密切相关。5-HT受体及其转运体基因在海洛因依赖发生发展中起到了重要的作用,是海洛因依赖的主要候选基因。探讨5羟色胺2A受体（Serotonin 2A receptor,HTR2A）基因启动子区-1438A/G（rs6311）、外显子区102T/C（rs6313）与5羟色胺1B受体（Serotonin 1B receptor,HTR1B）基因外显子区861G/C（rs6296）3个单核苷酸多态性和海洛因依赖的关联性分析。方法：严格按照诊断标准,选取无亲缘关系的海洛因依赖个体616例及健康个体600例提取基因组DNA,采用PCR-RFLP方法检测rs6311、rs6313和rs6296 3个SNPs位点的基因型频率,采用SPSS16.0软件分析各位点等位基因、基因型频率在病例-对照组间差异。结果：HTR2A基因rs6311和HTR1B基因rs6296位点的等位基因及基因型频率分布在2组间存在统计学差异（P〈0.05）,病例组rs6311位点的等位基因A频率显著高于对照组（X2=5.436,P=0.020,OR=1.208,CI=1.031~1.417）,rs6296位点的等位基因C频率显著高于对照组（X2=12.116,P=0.000,OR=1.329,CI=1.132~1.560）。连锁不平衡检验结果显示,HTR2A基因rs6311、rs6313位点处于不连锁状态,D＇〈0.5。结论：HTR2A基因rs6311和HTR1B基因rs6296多态性可能与海洛因成瘾有关,携带有rs6311 A等位基因与rs6296 C等位基因的人可能更容易对海洛因产生依赖。我们的研究为海洛因依赖易感人群筛选及药物靶向治疗提供了理论依据。     

Neurochemistry Underlying Relapse to Opiate Seeking Behaviour

Relapse is a major clinical problem and remains a major challenge in the treatment of addictions. A goal of current research is to gain a greater understanding of the neurochemistry underlying relapse to opiate use. Factors which trigger relapse in humans such as stress, exposure to opiates and/or drug-associated cues, can also trigger opiate-seeking in animals. This review will overview preclinical studies relating to the neurochemistry of opiate-seeking with a focus on studies published from 2005 to present.     

Loss of Protein Kinase C-αβ in Brain of Heroin Addicts and Morphine-Dependent Rats

Abstract: The biochemical status of human brain protein kinase C (PKC)-αβ during opiate dependence was studied by means of immunoblotting techniques in postmortem brain of heroin addicts who had died by opiate overdose. In the frontal cortex, a marked decrease (53%, p < 0.05) in the immunoreactivity of PKC-αβ was found in heroin addicts compared with matched controls. The loss of PKC-αβ in the brain of human addicts paralleled that observed in the frontal cortex of rats after chronic treatment with morphine (10–100 mg/kg i.p. for 5 days) (PKC-αβ decreased by 34%, p < 0.05). Chronic treatment with naloxone (1 mg/kg i.p. every 12 h for 5 days) did not alter PKC-αβ immunoreactivity in the rat brain. However, in morphine-dependent rats, naloxone-precipitated withdrawal induced a rapid and strong behavioral reaction with a concomitant up-regulation of PKC-αβ immunoreactivity to control values. These results indicated that the decrease of brain PKC-αβ induced by heroin/morphine is a μ-opioid receptor-mediated effect. The chronic administration of opiates has been associated with a marked sensitization of the adenylyl cyclase/cyclic AMP system, although this phenomenon is not exclusive of the opioid system but the general cellular adaptation to chronic inhibition of adenylyl cyclase. In this context, chronic treatment of rats with other inhibitory agonists (e.g., clonidine, 1 mg/kg i.p. every 12 h for 14 days) acting through receptors (e.g., α₂-adrenoceptors) also coupled to adenylyl cyclase did not alter brain PKC-αβ immunoreactivity. Together these findings suggest that the brain PKC system might play a major role in opiate addiction.     

Heroin dependence effects on some major and trace elements

In this study, 56 (14 control and 42 addicts) adult human subjects of both sexes of different periods of heroin dependence were subjected to the measurement of whole blood, serum, and red blood cell levels of some trace elements (zinc, managanese, iron copper, and bromine), as well as some major elements (phosphorus, sulfur, calcium, potassium, and chlorine). This was done by the energy-dispersive X-ray fluorescence (EDXRF) technique, in which copper and bromine showed a significant rise in whole blood (male) (22 and 32%, respectively), while zinc, iron, manganese, calcium, sulfur phosphorus, potassium, and chlorine showed a significant drop (49, 8, 25, 34, 21, 51, 61 and 72%, respectively) in proportion to the period of heroin intake (6 yr) and in comparison with the control group. No significant sexual variation has been reported.     

A Meta-Analysis of Chinese Herbal Medicine in Treatment of Managed Withdrawal from Heroin

Chinese herbal medicine has shown promise for heroin detoxification. This review extends a prior meta-analysis of Chinese herbal medicine for heroin detoxification, with particular attention to the time course of symptoms. Both English and Chinese databases were searched for randomized trials comparing Chinese herbal medicine to either α2-adrenergic agonists or opioid agonists for heroin detoxification. The methodological quality of each study was assessed with Jadad’s scale (1–2 = low; 3–5 = high). Meta-analysis was performed with fixed- or random-effect models in RevMan software; outcome measures assessed were withdrawal-symptoms score, anxiety, and adverse effects of treatment. Twenty-one studies (2,949 participants) were included. For withdrawal-symptoms score relieving during the 10-day observation, Chinese herbal medicine was superior to α2-adrenergic agonists in relieving opioid-withdrawal symptoms during 4–10 days (except D8) and no difference was found within the first 3 days. Compared with opioid agonists, Chinese herbal medicine was inferior during the first 3 days, but the difference became non-significant during days 4–9. Chinese herbal medicine has better effect on anxiety relieving at late stage of intervention than α2-adrenergic agonists, and no difference with opioid agonists. The incidence of some adverse effects (fatigue, dizziness) was significantly lower for Chinese herbal medicine than for α2-adrenergic agonists (sufficient data for comparison with opioid agonists were not available). Findings were robust to file-drawer effects. Our meta-analysis suggests that Chinese herbal medicine is an effective and safety treatment for heroin detoxification. And more work is needed to determine the specific effects of specific forms of Chinese herbal medicine.     

成人急性淋巴细胞白血病患者复发恐惧的影响因素及与社会支持的相关性研究

摘要 目的：探讨影响成人急性淋巴细胞白血病（ALL）患者复发恐惧的因素,分析复发恐惧与社会支持的相关性。方法：选择2017年5月至2021年5月我院收治的80例成人ALL患者,采用疾病进展恐惧简化量表（FoP-Q-SF）和社会支持评定量表（SSRS）对其进行评估,以单因素及多因素Logistic回归分析成人ALL患者复发恐惧的影响因素,采用Pearson相关分析成人ALL患者复发恐惧与社会支持的关系。结果：80例成人ALL患者的FoP-Q-SF评分为31～50分,平均（39.02±7.91）分,其中FoP-Q-SF评分≥34分者49例（高复发恐惧组）,占比达61.25%,FoP-Q-SF评分＜34分者31例（低复发恐惧组）。单因素分析结果显示：高复发恐惧组与低复发恐惧组在年龄、性别、个人月收入、是否有医疗保险以及社会支持方面比较差异具有统计学意义（P＜0.05）。进一步多因素Logistic回归分析结果显示：年龄18～45岁、女性、个人月收入≤3000元、社会支持较少是成人ALL患者复发恐惧的危险因素（P＜0.05）。高复发恐惧组SSRS各维度（主观支持、客观支持、对支持利用度）评分及总分均低于低复发恐惧组（P＜0.05）。Pearson相关性分析结果显示：成人ALL患者FoP-Q-SF评分与SSRS评分呈负相关（P＜0.05）。结论：成人ALL患者普遍存在复发恐惧心理,年龄、性别、个人月收入和社会支持是其影响因素,且社会支持水平与复发恐惧程度呈负相关。     

Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin

Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO₂%), end-tidal CO₂% (ETCO₂%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO₂% < 90% for >10s and ETCO₂% per breath >6.5%. Increases in ETCO₂% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO₂% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO₂% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO₂% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO₂% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.     

孕小鼠注射海洛因对仔鼠体重、行为及肺中相关活性物质表达的影响

为了探讨海洛因对仔鼠行为、体重及肺发育中KGF、c-Fos蛋白和Bax蛋白表达的影响,对4组共48例受孕小鼠(Mus musculus)从第8 d开始,每天早晚分别注射0.2 ml浓度为1.0 g/L、1.5 g/L和2.0 g/L的海洛因溶液和等量的生理盐水直到小鼠分娩,观察测量仔鼠行为及体重变化,采用免疫组织化学染色和体视学半定量方法检测15 d胚胎、出生后1 d.7 d、15 d仔鼠的肺中KGF、c-Fos蛋白和Bax蛋白表达情况.结果表明,海洛因影响仔鼠的行为活动,实验组各发育期仔鼠的体重明显低于对照组,海洛因组各发育期仔鼠肺中KGF、c-Fos蛋白和Bax蛋白的表达强度与对照组相比显著增强(P＜0.01或P＜0.05),且随海洛因浓度的增大表达越强,但随着发育的进行,海洛因组仔鼠肺中KGF、c-Fos蛋白和Bax蛋白的阳性表达减弱.海洛因影响仔鼠的行为与体重,海洛因对各发育期仔鼠肺的损伤可能与肺组织中KGF、c-Fos蛋白和Bax蛋白表达的增强有关.