可待因类止咳水成瘾治疗前后骨矿密度研究

Bone mineral density in codeine cough syrup addicts before and after detoxification rehabilitation treatment

目的应用双能X线骨密度仪,研究复方磷酸可待因止咳水成瘾者脱毒康复治疗前后骨矿密度的变化。方法以国际临床骨测量学会制定的骨密度测定方法学为标准,分别测量34例止咳水成瘾者经6个月以上脱毒康复治疗前后的骨密度,同时测量31例健康志愿者骨密度。测量体位包括腰椎、股骨近端和非优势侧前臂骨1/3段。比较止咳水成瘾者康复治疗前后骨矿密度的变化及测量Z值的差异。结果复方磷酸可待因止咳水成瘾组腰椎、左侧股骨近端和左侧前臂骨1/3段骨矿密度绝对值减低,皆明显低于健康对照组(t=-8.33、-10.14、-10.41,P均=0.000),测量Z值减低,超过正常值-2.0标准差(-2.0SD)范围,皆明显低于健康对照组(t=-10.84、-9.98、-13.07,P均=0.000),差异有统计学意义。经6个月以上脱毒康复治疗后,该成瘾组3组体位骨矿密度绝对值增加,皆高于治疗前水平(t=8.54、9.42、9.45,P均=0.000),测量Z值未见异常,在正常值-2.0标准差(-2.0SD)范围内,皆高于治疗前水平(t=7.74、8.21、8.79,P均=0.000),差异有统计学意义。结论经6个月以上的脱毒康复治疗后,滥用复方磷酸可待因止咳水产生成瘾的患者腰椎、股骨近端和前臂骨类似骨质疏松的病理变化得到明显改善。

Objective To study the changes in bone mineral density（ BMD） measured using Dual energy X-ray absorptiometry（ DXA） in compound codeine phosphate cough syrup addicts before and after detoxification rehabilitation treatment. Methods Using the International Society for Clinical Densitometry（ ISCD） guideline for BMD assessment,34 addicts and 31 healthy volunteers were recruited into the study. BMD of lumbar spine,proximal femur and distal 1 /3 forearm of the non-dominant side was assessed in the 34 addicts before and after detoxification rehabilitation treatment,and in the health volunteers. Quantitative analysis was made to compare differences in the BMD and Z-scores between the two groups. Results The BMD absolute values of lumbar spine,proximal femur and distal 1 /3 forearm of the non-dominant side in addicts were reduced. They were significantly lower than those of the healthy controls,with t values of- 8. 33,- 10. 14 and- 10. 41,respectively,and P values all 0. 000. Z-scores in addicts reduced more than- 2. 0 SD from the normal reference. They were significantly lower than those of the healthy control s,with t values- 10. 84,- 9. 98 and- 13. 07,respectively,and P values all 0. 000. The differences were statistically significant.After over 6 months of rehabilitation following detoxification treatment, the BMD values of addicts increased. They were significantly higher than those of before treatment,with t values 8. 54,9. 42 and 9. 45,respectively,and P value all 0. 000. In addition,Z-scores in treated addicts were in the normal range（ - 2. 0 SD）. Z-scores were significantly higher than those of pretreatment（ t = 7. 74,8. 21,8. 79,P = 0. 000）. The differences were statistically significant. Conclusion After over 6 months of rehabilitation following detoxification treatment,the pathological changes similar to osteoporosis in lumbar spine,proximal femur and forearm of the addicts improved significantly.