海洛因依赖者不同剂量美沙酮治疗前后促肾上腺皮质激素和糖皮质激素水平的变化

Changes of levels of adrenocorticotropin and glucocorticoids in heroin-dependent patients before and after treated with different doses of methadone

目的:观察海洛因依赖者用不同剂量美沙酮治疗前后促肾上腺皮质激素(adrenocorticotropin,ACTH)、糖皮质激素(glucocorticoids,GC)及戒断反应强度的变化。方法:将20例海洛因依赖者按入院次序分为全量美沙酮治疗组(n=10),小剂量美沙酮治疗组(n=10),利用放免法测定各治疗组治疗前后ACTH、皮质醇的浓度,并对各组戒断症状在治疗前、治疗不同时期进行评分。结果:治疗前全量美沙酮治疗组和小剂量美沙酮治疗组的ACTH、皮质醇浓度较高,ACTH浓度分别为(18.2±8.2)和(14.2±9.4)ng/L;皮质醇浓度分别为(34.4±5.3)和(33.9±8.9)ng/L;此时两组戒断评分分值较高,分别为29.83±3.17和27.66±2.87。使用不同剂量美沙酮治疗后第3和第10天,各组ACTH、皮质醇浓度和戒断评分分值较治疗前下降。其中全量美沙酮控制戒断症状作用较小剂量美沙酮治疗组好,在治疗第3天和第10天该组的ACTH、皮质醇浓度分别为(11.5±5.4)和(9.8±2.8)ng/L;(26.7±10.0)和(20.8±6.0)ng/L,较治疗前下降明显(t=2.15～4.98,P<0.05)。结论:海洛因依赖者使用不同剂量美沙酮治疗前后,戒断症状分值及下丘脑-垂体-肾上腺轴激素分泌呈先升后降的双向变化,减轻戒断反应可减轻海洛因依赖者ACTH、皮质醇水平。戒断反应可能作为一种应激源引起海洛因依赖者ACTH、?

AIM:To study the changes of adrenocorticotropin(ACTH) and glucocorticoids(GC) levels in heroin dependent patients before and after treated with different doses of methadone.METHODS:Twenty patients with heroin dependence were assigned to two groups according to their hospitalization time:sufficient dose of methodane group(n=10) and low dose of methodane group(n=10).The levels of ACTH and cortisol were determined with radioimmunoassay(RIA) in the 20 heroin addicts before and after methadone therapy, and the withdrawal scores were also measured in the two groups before and at different time after therapy.RESULTS:Before detoxification,the concentrations of ACTH and cortisol were higher than normal value,(18.2±8.2) and (14.2±9.4) ng/L for the former,(34.4±5.3) and (33.9±8.9) ng/L for the latter in the two groups,and meanwhile,the withdrawal scores in these two groups were also high,29.83±3.17 and 27.66±2.87,respectively.On the third and tenth days after different doses of methadone therapy,the levels of ACTH and cortisol,and withdrawal scores were all decreased,as compared those before therapy.The detoxification in the sufficient dose of methodane group was better than that in the low dose of methodane group.On the third and tenth day of the treatment,the concentrations of ACTH and cortisol were (11.5±5.4),(9.8±2.8) ng/L and (26.7±10.0),(20.8±6.0) ng/L respectively,significant lower than those before treatment(t=2.15 to 4.98,P< 0.05).CONCLUSION:Hormones of hypothalamus pituitary adrenocortical(HPA) axis and withdrawal reaction change in a biphasic manner in heroin dependent patients before and after treated with different doses of methadone.The relief of withdrawal reaction can decrease the levels of ACTH and cortisol in such patients.Withdrawal reaction as a probable stressor,can induce the increase of ACTH and cortisol concentrations of heroin addicts.