Distinctive aspects of peptic ulcer disease,Dieulafoy'slesion,and Mallory-Weiss syndrome in patients withadvanced alcoholic liver disease or cirrhosis

AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWS)in patients with advanced alcoholic liver disease(a ALD),including alcoholic hepatitis or alcoholic cirrhosis.METHODS:Computerized literature search performed via Pub Med using the following medical subject heading terms and keywords:"alcoholic liver disease","alcoholic hepatitis","alcoholic cirrhosis","cirrhosis","liver disease","upper gastrointestinal bleeding","nonvariceal upper gastrointestinal bleeding","PUD",‘‘DL’’,‘‘Mallory-Weiss tear",and"MWS’’.RESULTS:While the majority of acute gastrointestinal(GI)bleeding with a ALD is related to portal hypertension,about 30%-40%of acute GI bleeding in patients with a ALD is unrelated to portal hypertension.Such bleeding constitutes an important complication of a ALD because of its frequency,severity,and associated mortality.Patients with cirrhosis have a markedly increased risk of PUD,which further increases with the progression of cirrhosis.Patients with cirrhosis or a ALD and peptic ulcer bleeding(PUB)have worse clinical outcomes than other patients with PUB,including uncontrolled bleeding,rebleeding,and mortality.Alcohol consumption,nonsteroidal anti-inflammatory drug use,and portal hypertension may have a pathogenic role in the development of PUD in patients with a ALD.Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients.The frequency of bleeding from DL appears to be increased in patients with a ALD.DL may be associated with an especially high mortality in these patients.MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism,and is associated with a ALD.Patients with a ALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics.Preendoscopic management of acute GI bleeding in patients with a ALD unrelated to portal hypertension is similar to the management of a ALD patients with GI bleeding from portal hypertension,because clinical distinction before endoscopy is difficult.Most patients require intensive care unit admission and attention to avoid over-transfusion,to correct electrolyte abnormalities and coagulopathies,and to administer antibiotic prophylaxis.Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal.Prompt endoscopy,after initial resuscitation,is essential to diagnose and appropriately treat these patients.Generally,the same endoscopic hemostatic techniques are used in patients bleeding from PUD,DL,or MWS in patients with a ALD as in the general population.CONCLUSION:Nonvariceal upper GI bleeding in patients with a ALD has clinically important differences from that in the general population without a ALD,including:more frequent and more severe bleeding from PUD,DL,or MWS.

Research progress on the relationship between proBDNF and alcohol dependence and its related cognitive impairment

Brain-derived neurotrophic factor(BDNF)plays an important role in the growth,develop-ment,differentiation,injury,repair,survival and apoptosis of nerve cells.Precursor of BDNF(proBDNF)is an im-portant regulator of neurodegeneration,long-term hippo-campal inhibition and synaptic plasticity.Alcohol depen-dence syndrome(ADS)is a group of chronic recurrent diseases with unknown etiology.Current studies believe that proBDNF plays an important role in the occurrence,development and outcome of ADS.Alcohol dependence patients,like other neurodegenerative diseases,will also have different degrees of cognitive impairment.This arti-cle reviews the research progress on the relationship be-tween BDNF,proBDNF,alcohol dependence and cogni-tive impairment.

A Clinical Study:Therapeutic Effects of Repetitive Transcranial Magnetic Stimulation and Cognitive Behavioral Therapy on Cognitive Impairment in Alcohol-Dependent Patients

Objective To observe the effects of repetitive transcranial magnetic stimulation(rTMS)and cognitive behavioral therapy(CBT)on cognitive function in alcohol-dependent patients.Methods Data from 285 alcohol-dependent patients were collected from Mudanjiang Medical University and Sun Yat-sen Memorial Hospital at Sun Yat-sen University between 2019 and 2021.The patients were divided into groups depending on alcohol abstinence and non-abstinence.There were 43 patients in the alcohol consumption(AC)group.The patients in the abstinence group were randomly assigned to treatment regimens with different combinations of rTMS and CBT using the Elton system.There were 49 patients in the TB+C0 group,36 in the TB+C1 group,44 in the TL+C0 group,36 in the TL+C1 group,37 in the TR+C0 group,and 40 in the TR+C1 group.Cognitive function was assessed by using the Montreal Cognitive Assessment Scale(MoCA).Results The proportion of patients with cognitive impairment in the AC group at 24 weeks was higher than that at baseline(P<0.05),whereas the proportion of cognitive impairment in the other groups did not differ significantly over time.The percentage of patients with cognitive impairment at 24 weeks was 52.3%in the TL+C0 group and 47.2%in the TL+C1 group,which was significantly lower than that in the AC group(P<0.05).MoCA scores at different time points in the AC group were significantly higher than those in the TB+C0,TL+C0,TL+C1,TR+C0,and TR+C1 groups,respectively.MoCA scores were significantly higher at 12 weeks compared with the baseline in the TB+C0,TL+C0,TL+C1,TR+C0,and TR+C1 groups(P<0.05),and similar changes were observed at 24 weeks.The MoCA scores in the TL+C1 and TL+C0 groups were higher than those in the TR+C0 group at 12 weeks after the intervention(P<0.05).Furthermore,MoCA scores in each of the TB+C1,TL+C1,TL+C0,TR+C1,and TR+C0 groups were higher than those in the AC group at 24 weeks(P<0.05).Conclusion Alcohol consumption impairs cognitive function,as evidenced by a significantly higher proportion of cognitive impairment after 24 weeks of non-abstinence.Most of the tested treatment regimens improved cognitive function.High frequency rTMS of the left dorsolateral prefrontal cortex(DLPFC)was associated with a greater improvement in cognitive function than that of the right DLPFC in alcohol-dependent patients at 12 weeks of abstinence.There does not appear to be a therapeutic advantage of CBT for cognitive impairment in alcohol-dependent patients.Screening for impaired cognitive function should be seriously considered for patients who engage in heavy drinking,and measures should be taken to reduce the risk of dementia induced by alcohol dependence.

酒精依赖综合征患者血清生化指标及其预测价值分析

目的了解酒精依赖综合征患者血清生化指标水平及其早期预测价值。方法对212例酒精依赖综合征患者(研究组)和185名健康志愿者(对照组)的临床资料进行回顾性分析,比较两组受试者的年龄及血清生化指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、总胆汁酸(TBA)、总蛋白(TP)、同型半胱氨酸(HCY)、尿酸(UA)、胱抑素C(Cys-C)、胆碱酯酶(CHE)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、葡萄糖(GLU)]。采用Logistic回归分析探讨血清生化指标与酒精依赖综合征发病的关系,采用Spearman分析探讨血清生化指标与饮酒情况的关系,绘制受试者工作特征(ROC)曲线分析AST、TP、HDL-C、HCY、Cys-C对酒精依赖综合征的早期预测价值。结果研究组受试者血清ALT、AST、LDH、TBA、HDL-C、HCY、Cys-C水平高于对照组,年龄及血清CHE、TP、TG、LDL-C、GLU水平低于对照组(P<0.01)。回归分析结果显示,AST、TP、HDL-C、HCY、Cys-C均是酒精依赖综合征的影响因素(P<0.05或0.01);Spearman相关分析结果显示,酒精依赖综合征患者TP水平与饮酒时间、成瘾时间呈负相关(P<0.05),Cys-C水平与饮酒时间、成瘾时间呈正相关(P<0.01)。ROC曲线分析结果显示,AST、TP、HDL-C、HCY、Cys-C联合预测酒精依赖综合征的曲线下面积为0.981,95%CI为0.961~0.992,灵敏度和特异度分别为92.61%、96.22%,均优于单项指标预测价值(P<0.05)。结论AST、TP、HDL-C、HCY、Cys-C是预测酒精依赖综合征的有效指标,其联合预测价值较高,对酒精依赖综合征的辅助诊断及临床治疗具有一定的临床应用价值。

Alcohol liver disease: A review of current therapeutic approaches to achieve long-term abstinence

Harmful alcohol drinking may lead to significant damage on any organ or system of the body.Alcoholic liver disease(ALD) is the most prevalent cause of advanced liver disease in Europe.In ALD,only alcohol abstinence was associated with a better long-term survival.Therefore,current effective therapeutic strategy should be oriented towards achieving alcohol abstinence or a significant reduction in alcohol consumption.Screening all primary care patients to detect those cases with alcohol abuse has been proposed as population-wide preventive intervention in primary care.It has been suggested that in patients with mild alcohol use disorder the best approach is brief intervention in the primary care setting with the ultimate goal being abstinence,whereas patients with moderate-to-severe alcohol use disorder must be referred to specialized care where detoxification and medical treatment of alcohol dependence must be undertaken.

Therapeutic Efficacy Observation on Acupuncture for Post-withdrawal Syndrome of Heroin Dependence

Obj ective： To observe and analyze the intervention effects of needling different points for post- withdrawal syndrome of heroin dependence, and thus provide clinical basis for screening specific points. Methods： A total of 60 males with heroin dependence were randomly allocated into 3 groups, the Neiguan （PC 6） group, the Shenmen （HT 7） group and the control group. The results were observed and evaluated before, during, and 3 weeks after treatment using the rating scale for post-withdrawal syndrome and Hamilton anxiety scale （HAMA）. Results： In regards to the control of post-withdrawal symptoms, the groups of Neiguan （PC 6） and Shenmen （HT 7） showed statistical difference when compared with the control group （P〈0.05, P〈0.01）; however, there was no statistical difference between the Neiguan （PC 6） group and Shenmen （HT 7） group （P〉0.05）. Conclusion： Acupuncture can alleviate the post-withdrawal syndrome and anxiety of heroin dependence. Although both Neiguan （PC 6） and Shenmen （HT 7） have equally remarkable effects, Shenmen （HT 7） have a better tendency for marked effect for heart-mind related symptoms.

升阳泻湿法治疗非酒精性脂肪性肝病初探

非酒精性脂肪性肝病是目前的多发病,为多因素所致,严重影响公共健康,目前对于该病的证治报道较多。该病的临床表现多数不典型,病机证候复杂,笔者汲取李东垣理论思想中升发脾之清气,以及黄元御理论思想中泻湿疏木的治法,把二者进行优化组合,拟定了升阳化湿,培土疏木为治疗大法运用于临床,立足于“湿”,分为“湿浊内蕴”和“脾虚湿困”2个证型,驭繁就简,取得了理想的临床疗效。

电针治疗尼古丁依赖的疗效观察

目的观察电针治疗尼古丁依赖的临床疗效。方法将60例尼古丁依赖者用随机数字表法分为电针组和对照组,每组30例。对照组采用口服酒石酸伐尼克兰片治疗,电针组予电针治疗。分别于治疗前以及治疗第3天、治疗第1周、治疗第2周、治疗第3周、治疗第4周和第16周随访时,观察两组吸烟量、烟草依赖评估量表(fagerstorm test for nicotine dependence,FTND)、吸烟严重度指数(heaviness of smoking index,HSI)、吸烟渴求简短问卷(brief questionnaire of smoking urges,QSU-Brief)和明尼苏达尼古丁戒断症状量表(Minnesota nicotine withdrawal scale,MNWS)评分的变化。结果治疗第4周及第16周随访时,两组吸烟量、FTND、HSI、QSU-Brief和MNWS的评分均较治疗前降低(P<0.05)。治疗第3天以及治疗第1、第2和第3周,电针组吸烟量评分低于对照组(P<0.05);治疗第4周,两组吸烟量评分比较,差异无统计学意义(P>0.05)。治疗第3天以及治疗第1、第2和第3周,电针组QSU-Brief评分低于对照组(P<0.05);治疗第4周及第16周随访时,两组QSU-Brief评分比较,差异无统计学意义(P>0.05)。结论电针可改善尼古丁依赖者的戒断症状,临床疗效优于口服酒石酸伐尼克兰片,电针疗效的累积效应与时间呈正相关。

经皮穴位电刺激在酒精依赖患者中的应用效果

目的观察经皮穴位电刺激在酒精依赖患者心理渴求和稽延性戒断症状中的应用效果。方法选取在湖南省脑科医院酒瘾科住院的120例酒精依赖完成急性脱瘾期的男性患者为研究对象,根据患者治疗方式的不同分为常规药物组、经皮穴位电刺激组及假刺激组,每组40例。常规药物组采用苯二氮[艹卓]类药物替代递减以及支持性对症治疗,经皮穴位电刺激组采用常规治疗联合经皮穴位电刺激,假刺激组采用常规治疗联合模拟经皮穴位电刺激。比较3组患者治疗前后焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分、饮酒迫切性量表(AUQ)评分、视觉模拟评分法(VAS)评分、匹兹堡睡眠质量指数(PSQI)评分及复发情况。结果治疗后,3组患者SAS、SDS、AUQ及VAS评分均较治疗前降低,且经皮穴位电刺激组以上评分均低于常规药物组及假刺激组,差异有统计学意义(P<0.05)。治疗后,3组患者睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍评分及PSQI总分均低于治疗前,且经皮穴位电刺激组以上评分均低于常规药物组及假刺激组,差异有统计学意义(P<0.05)。经皮穴位电刺激组复发率低于常规药物组及假刺激组,差异有统计学意义(P<0.05)。结论相较于常规治疗及模拟经皮电刺激,经皮穴位电刺激治疗更有利于减轻患者焦虑、抑郁及失眠等稽延性戒断症状严重程度,并利于降低患者心理渴求程度,从而降低复发率。

苦黄颗粒治疗湿热蕴结型非酒精性脂肪性肝病临床研究

目的:观察苦黄颗粒治疗湿热蕴结型非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)的临床疗效。方法:将62例NAFLD患者按照随机数字表法分为对照组和治疗组,每组各31例。对照组给予多烯磷脂酰胆碱治疗,治疗组在对照组治疗的基础上加用苦黄颗粒。测定两组患者治疗前后肝脏受控衰减指数(controlled attenuation parameter,CAP)及肝脏硬度值(liver stiffness measurement,LSM);比较两组患者治疗前后中医证候积分、血脂[高密度脂蛋白(high density lipoprotein cholesterol,HDL)、三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)]及肝功能[(丙氨酸转氨酶(alanine transaminase,ALT)、天冬氨酸转氨酶(aspartateaminotransferase,AST)、γ-谷氨酰转肽酶(γ glutamyltranspeptidase,GGT)]变化情况。比较两组患者临床疗效、肝脏脂肪定量疗效及腹部彩超测定肝脏脂肪疗效。结果:(1)磁共振肝脏脂肪定量疗效:治疗组有效率为95.00%,显著高于对照组的84.00%,差异具有统计学意义(P<0.05)。(2)腹部彩超测定肝脏脂肪疗效:治疗组有效率为93.50%,高于对照组的77.40%,差异具有统计学意义(P<0.05)。(3)临床疗效:治疗组有效率为90.32%,高于对照组的61.29%,差异具有统计学意义(P<0.05)。(4)两组患者治疗后CAP值低于本组治疗前,且治疗后治疗组低于对照组(P<0.05)。(5)两组患者治疗后AST、ALT、GGT低于本组治疗前,且治疗后治疗组低于对照组(P<0.05)。(6)两组患者治疗后TC低于本组治疗前,且治疗后治疗组低于对照组,差异具有统计学意义(P<0.05);两组患者TG及HDL比较,差异无统计学意义(P>0.05)。(7)两组患者治疗后LSM值小于本组治疗前,差异具有统计学意义(P<0.01),但治疗后组间比较,差异无统计学意义(P>0.05)。(8)两组患者治疗后周身困重、脘腹胀满或疼痛、大便黏滞不爽、口干口苦等中医证候积分比较,差异具有统计学意义(P<0.05)。结论:苦黄颗粒治疗湿热蕴结型NAFLD,可减轻肝脏脂肪含量,改善肝功能,降低血脂水平,且能有效缓解临床症状。

土茯苓、省头草药对治疗湿热蕴结型代谢相关脂肪性肝病经验

代谢相关脂肪性肝病(MAFLD)的核心病机为本虚标实,本虚为肝脾肾亏虚,标实则以痰、湿、瘀、热为要,临床常见湿热壅盛之象。土茯苓、省头草是临床治疗湿热蕴结型MAFLD的常用药对,二药配伍内外、上中下三焦同治,可清化痰湿秽浊、健脾和中。灵活使用土茯苓、省头草药对,可有效改善MAFLD患者的湿热证候。并附验案1则。

疏肝健脾方联合中药外敷治疗肝郁脾虚型非酒精性脂肪性肝病临床观察

目的 观察自拟疏肝健脾方联合中药外敷方治疗肝郁脾虚型非酒精性脂肪性肝病(NAFLD)的临床效果。方法 将100例符合条件的患者随机分为2组,对照组50例采用多烯磷脂酰胆碱胶囊治疗,观察组予自拟疏肝健脾方联合外敷方治疗。2组的疗程均为3个月,疗程结束后评定效果。结果 观察组在改善肝功能、血脂、中医症状方面均显著优于对照组。观察组的总有效率为92.00%(46/50),高于对照组的72.00%(36/50),差异具有统计学意义(P<0.05)。结论 疏肝健脾法联合外敷方治疗肝郁脾虚型NAFLD效果显著。

云南汉族酒精依赖综合征与ADH2、ALDH2基因多态性的关联研究

目的了解乙醇脱氢酶2(ADH2)和乙醛脱氢酶2(ALDH2)的不同基因型及等位基因频率在云南汉族酒精依赖综合征患者组和健康对照组的分布差异。方法应用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)分析法,对ADH2基因和ALDH2基因的特定片段进行特异性扩增,限制性内切酶酶切,非变性聚丙烯酰胺凝胶垂直电泳检测,结合硝酸银染色法判定基因型。结果 ADH2基因存在2种等位基因(ADH2*1、ADH2*2)和3种基因型(ADH2*1/*1、*1/*2和*2/*2),2种等位基因的分布在两组的差异有统计学意义(P<0.05),ADH2*2等位基因频率在酒精依赖综合征患者组降低,3种基因型的分布在两组无显著差异(P>0.05)。ALDH2基因存在2种等位基因(ALDH2*1、ALDH2*2)和3种基因型(ALDH2*1/*1、*1/*2和*2/*2),2种等位基因和3种基因型的分布在两组中的差异均有统计学意义(P<0.05),酒精依赖综合征患者组AL-DH2*1/*2基因型和ALDH2*2等位基因频率降低。结论 ADH2*2等位基因和ALDH2*2等位基因对于酒精依赖综合征发病有保护作用。

针刺对海洛因依赖的脱毒疗效及其防复吸潜力的临床研究

目的 比较针刺、针刺加阿片、阿片加丁丙诺啡及阿片加韩氏戒毒仪 4种方法的脱毒疗效及其对脱毒末期稽延性戒断症状和心理渴求的影响。方法 应用戒断症状量表观察脱毒疗效 ,应用视觉类比量表 (VAS)研究心理渴求程度。结果 针刺改善海洛因依赖者戒断症状的优势主要表现在治疗的第 6天以后 ,改善渴求心理的优势表现在第 8天以后 ,且无明显副作用。结论 针刺具有防复吸潜力 。

针灸结合中医情志疗法改善酒精依赖患者抑郁症状的疗效观察

目的:观察针灸结合中医情志疗法对酒精依赖患者抑郁症状的改善情况。方法:将酒精依赖伴抑郁症状的患者60例,随机分为两组,分别只采用中医情志治疗(对照组)和针灸结合中医情志治疗(治疗组)治疗3个月。在治疗前及治疗后的3、6、9周,采用汉密尔顿抑郁量表(HAMD)进行疗效评定,并进行酒精线索诱导前后心理渴求评价。结果:针灸结合中医情志治疗组疗效优于对照组(P<0.05),两组治疗后HAMD评分差异有显著性(P<0.01),心理渴求降低(P<0.01)。结论:将针灸与中医情志疗法相结合,对酒精依赖患者抑郁症状有良好的治疗作用。

基于结构化临床信息采集系统的2型糖尿病辨证分型研究

目的:研究2型糖尿病辨证及三型辨证的客观性与实用性。方法:经结构化临床信息采集系统采集533例2型糖尿病患者的诊疗信息,经计算机分型。结果:509例(95.6%)取得分型者中:阴虚证286例(56.2%),气虚证233例(45.8%),阳虚证180例(35.4%),热盛证179例(35.2%),湿痰证159例(31.2%),湿热证80例(15.7%),血瘀证350例(68.8%)。复证394例(77.4%)、单证115例(22.6%)。具体证型54种。阴虚热盛、气阴两虚、阴阳两虚及其兼证共222例(43.6%)。单纯虚证62例,复合虚证10例,单纯实证53例,血瘀证43例,复合实证28例;虚实夹杂证356例(69.9%)。在三大并发症组中气阴两虚型最多。结论:2型糖尿病证型复杂,三型辨证具有一定客观性与实用性。

乙醇依赖综合征与ADH2、CYP4502E1基因多态性的相关研究

目的对云南汉族酒依赖综合征与ADH2、CYP4502E1基因多态性进行相关性研究;方法采用PCR-RFLP方法,对来自云南地区的44例乙醇依赖综合征患者以及与其配比的30例对照个体的ADH2基因第3外显子处G143A单核苷酸多态位点等位基因频率和基因型频率、CYP2E1基因5′端非编码区的RsaI/PstI酶切位点多态性等位基因频率和基因型频率以及是否与乙醇依赖综合征相关进行分析。结果(1)在患者组ADH2基因3种基因型ADH2*1/*1、ADH2*1/*2、ADH2*2/*2分别为36%、43%、21%,患者组和对照组相比较无显著差异(P>0.05);等位基因ADH2*1和ADH2*2在患者组中的基因频率为0.58和0.42,患者组和对照组相比较分布有差异(P<0.05),患者组ADH2*2等位基因频率降低;(2)CYP2E1基因在患者组中A、B型基因分布为59%、41%,患者组和健康对照组两种基因型的分布有差异(P<0.05),B型基因在乙醇依赖组升高;等位基因c1和c2在患者组中的频率为0.80和0.20,患者组和对照组两种等位基因分布有差异(P<0.05),患者组c2等位基因频率升高。结论CYP2E1基因多态性与乙醇依赖综合征发生有关,ADH2*2等位基因对于乙醇依赖综合征发病有保护作用,而c2等位基因在乙醇依赖综合征的发生中起一定的作用。

ADH2,ALDH2和CYP4502E1遗传多态性与云南汉族酒依赖综合征患者的关联研究

背景:酒精依赖综合征,也称为酒精中毒或者酒精成瘾,与遗传、生理、心理、社会环境等诸多因素有关。目前的研究揭示,酒依赖是一种多因子控制的复杂疾病,由多个基因共同控制,并且是遗传因素与环境因素以一种极其复杂的方式相互作用下的产物,而超过一半的饮酒风险度由遗传因素决定。与酒精依赖有关的基因主要包括两大类:一类是药物代谢动力学基因,这类基因编码的蛋白质是乙醇在体内代谢的重要酶类,包括乙醇脱氢酶(alcohol deydrogenase,ADH)基因,乙醛脱氢酶(aldehyde dehydrogenase,ALDH)基因,细胞色素P450第2家族E亚系多肽1(cytochromeP450,family2,subfamilyE,polypeptide1,CYP2E1);另一类是药物效应动力学基因,这类基因编码的蛋白质与乙醇在大脑的蓄积及随后产生的一系列精神依赖密切相关,主要包括儿茶酚氧位甲基转移酶(catechol-O-methyltransferase,COMT)基因、多巴胺受体D2(dopamine receptor D2,DRD2)基因、5-羟色胺受体(5-hydroxytryptamine receotor,5-HTR)基因、γ-氨基丁酸A受体β3(γ-aminobutyric acid Areceptor β3,GABAAβ3)基因、多巴胺转运体(dopamine transporter,DAT)基因和μ阿片受体基因(Mu opioid receptor gene,OPRM1)。目的:研究ADH2,ALDH2和CYP4502E1基因多态性与云南汉族酒依赖患者的相关性。本课题对云南汉族酒依赖患者组和非酒依赖对照组人群的ADH2、ALDH2和CYP2E1三个乙醇代谢相关基因多态性进行研究,探讨云南汉族ADH2、ALDH2和CYP2E1基因多态性和酒依赖的相关性,旨在从分子遗传学角度探讨酒精依赖综合征的发病机制,寻找其发生的潜在危险因素,为进一步开展酒精依赖综合征的病因学以及遗传学研究寻找理论依据。方法:选择2006-20083a来云南省精神病医院酒精依赖治疗科住院治疗患者80例。入组标准:(1)年龄21-65a,性别不限,汉族;(2)符合《精神疾病的诊断及统计手册》(DSMIV)酒依赖诊断标准;(3)饮酒10a以上,每天饮酒二两以上(白酒)或六瓶啤酒以上。排除标准:(1)精神分裂症、心理障碍、强迫症或其他严重精神障碍病史;(2)其他药物滥用史或成瘾史(烟草除外);(3)精神疾病阳性家族史。以及来自昆明医学院第一附属医院体检中心100例健康体检者作为对照组,其民族、年龄与上述病例组相匹配,既往无精神病史及精神疾病阳性家族史。结果:酒依赖患者组和健康对照组相比较,ADH2基因座ADH2*1/ADH2*1、ADH2*1/ADH2*2、ADH2*2/ADH2*2三种基因型的分布无显著差异(P>0.05),ADH2*1和ADH2*2两种等位基因分布有差异(P<0.05),在健康对照组ADH2*2等位基因频率高于酒依赖患者组;ALDH2基因座基因型及等位基因分布均差异有统计学意义(P>0.05),在健康对照组ALDH2*1/*2基因型及ALDH2*2等位基因频率高于酒依赖患者组;CYP4502E1基因座c1/c1和c1/c2两种基因型的分布差异具有统计学意义(P<0.05),c1/c2基因型在酒依赖患者组升高;c1和c2两个等位基因分布差异有统计学意义(P<0.05),c2等位基因在酒依赖患者组频率升高。结论:ADH2*2和ALDH2*2等位基因对于酒依赖发病有保护作用,而c2等位基因在酒依赖的发生中起一定的作用。

呋喃唑酮合并认知行为疗法治疗酒依赖对照研究

目的:评价呋喃唑酮合并认知行为疗法对酒依赖的治疗效果。方法:将55例酒依赖患者随机分为两组,联合治疗组给予呋喃唑酮合并认知行为治疗,呋喃唑酮组单用呋喃唑酮治疗,应用临床疗效标准及酒依赖严重程度问卷(SADQC)定期评定。疗程6个月。结果:在治疗1、2、4个月和6个月时,联合治疗组疗效显著优于呋喃唑酮组,尤其是对情感性戒断症状疗效更好。结论:呋喃唑酮合并认知行为疗法治疗酒依赖效果优于单用呋喃唑酮治疗。

盐酸曲唑酮治疗酒依赖稽延性戒断症状100例临床研究

目的探讨盐酸曲唑酮治疗酒依赖稽延性戒断症状的有效性和安全性。方法采用随机、双盲、安慰剂对照的方法把100例符合纳入和排除标准的患者分成盐酸曲唑酮组和安慰剂组。每个患者均口服盐酸曲唑酮或安慰剂每日3次,每次1片,疗程均为8周。8周内按时分别进行汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAM D)、匹兹堡睡眠质量指数(PSQ I)、副反应量表(TESS)评分及必要的辅助检查,1年后调查复饮情况。结果有81例完成治疗,有19例因提前出院或失访未完成治疗脱失。盐酸曲唑酮组(41例)汉密顿焦虑量表、汉密顿抑郁量表及匹兹堡睡眠质量指数评分治疗后与治疗前比较,总分值逐渐下降,2周后上述3项评分和安慰剂组(40例)分别比较差异有显著性(t=2.23,2.12,2.27;P均<0.05);1年后复饮率盐酸曲唑酮组明显低于安慰剂组(χ2=5.87,P<0.05)。治疗后两组副反应量表评分比较差异无显著性(t=0.08,P>0.05)。结论盐酸曲唑酮能有效改善酒依赖戒断后患者焦虑、抑郁及失眠症状和有效降低复饮;未发现明显药物不良反应,安全性高。