中药治疗海洛因依赖急性戒断症状的Meta分析

A META-ANALYSIS OF CHINESE HERBAL MEDICINE IN TREATMENT OF MANAGED WITHDRAWAL FROM HEROIN

目的:系统评价中药治疗海洛因依赖急性戒断症状的有效性与安全性。方法:计算机检索多种中英文数据库,收集中、西药(α2-肾上腺素受体激动剂或阿片受体激动剂)对比研究海洛因脱毒的随机对照实验(RCT)。采用Jadad量表对纳入研究进行质量评价,并采用RevM an软件以固定效应和随机效应模型进行M eta分析。评价指标包括:戒断症状评分、焦虑评分及不良反应发生率。结果:共纳入21个实验(共2949位受试者)。结果显示:对于戒断症状的缓解,在疗程的d4-10(d8除外),中药组优于α2-受体激动剂组,在疗程的前3 d,两者无显著性差异。与阿片受体激动剂相比,在疗程前3 d,中药略显逊色,但在疗程d4-9,两者疗效相当。对于焦虑的缓解,中药组与阿片受体激动剂组相比无显著性差异,但与α2-受体激动剂组相比,中药在疗程后期显示出优越性。另外,在某些不良反应(疲乏、眩晕)发生率上,中药组也显著低于α2-受体激动剂组(阿片受体激动剂组数据不足,未分析)。结论:现有数据表明,中药是海洛因依赖脱毒有效而安全的治疗方法。但对于中药特定方剂的特定疗效还需要有进一步的研究。

Objective：To assess the effectiveness and safety of Chinese medicine in the treatment of opioid withdrawal symptoms. Methods： 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. Meta analysis was performed with fored - or random - effect models in RevMan software; outcome measures assessed were withdrawal - symptoms score, anxiety, and adverse effects of treatment. Results： Twenty - one studies （2949 participants） were included. For withdrawal symptoms score relieving during the 10- day observation, Chinese herbal medicine was superior to or2 -adrenergic agonists in relieving opioid -withdrawal symptoms during 4 - 10 days （except dS） 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 d 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. Conclusion：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.