Abstinence Following a Motivation-Skill-Desensitization-Mental Energy Intervention for Heroin Dependence: A Three-year Follow-up Result of a Randomized Controlled Trial

The high rate of relapse among heroin users remains a significant public concern in China. In the present study, we utilized a Motivation-Skill-Desensitization-Mental Energy (MSDE) intervention and evaluated its effects on abstinence and mental health. Eighty-nine male heroin users in a drug rehabilitation center were enrolled in the study. The participants in the MSDE intervention group (n=46) received MSDE intervention, which included motivational interviewing, coping skills training, eye movement desensitization and reprocessing, and mindfulness-based psychotherapy. The participants in the control group (h=43) received a series of lectures on skills training. A significant increase in Contemplation Ladder score (P<0.001) and decreases in scores on the Obsessive Compulsive Drug Use Scale (P<0.001), Beck Depression Inventory (P<0.001), and Aggression Questionnaire (P=O.O33) were found immediately after intervention. Compared to the control group, the MSDE intervention group reported significantly higher abstinence rates (P=0.027) and retention rates (P<0.001) at follow-up. Overall, the MSDE intervention, which uses a combined strategy for relapse prevention, could be a promising approach for preventing relapse among heroin users in China.

Roscovitine促进增殖期PC12细胞凋亡

目的探讨细胞周期蛋白依赖激酶(CDK)抑制剂Roscovitine导致增殖期PC12细胞死亡的性质和CDK调控的细胞周期与细胞凋亡的关系。方法利用培养的增殖期PC12细胞模型,进行MTT细胞活性检测、Hoechst 33342胞核荧光染色和倒置显微镜观察。结果分别用5、10、20、50和100μmol/L浓度的Roscovitine溶液处理细胞12 h,细胞存活率呈剂量依赖性下降;另外,50μmol/L浓度的Roscovitine分别处理细胞41、2、24和48 h,细胞死亡也呈现时间依赖性。细胞死亡的形态学表现是细胞皱缩、核染色体固缩和核碎片形成。结论Roscotivine导致的增殖期PC12细胞凋亡与CDK调控的细胞周期蛋白有关。

PC斜拉桥的时变分析——不定性分析

从分析影响混凝土收缩徐变的不定性因素入手，通过对现有各种收缩徐变计算模式的比较，认为ＢＰ—ＫＸ模式不仅可以考虑混凝土成分的影响，而且还考虑了环境条件（如温度、相对湿度等）对混凝土收缩徐变的影响，是当前进行时变不定性分析的最佳模式。通过对其随机化，建立了进行不定性分析的随机模型。经对多种不定性分析方法进行研究比较之后，将一种新的不定性分析方法——Ｎｅｕｍａｎｎ展开ＭｏｎｔｅＣａｒｌｏ法应用于ＰＣ斜拉桥的时变分析中。该方法既可以提高计算速度，又可以处理温度和相对湿度等随机过程对结构时变的影响。通过对红水河铁路斜拉桥的计算与实桥测试数据的比较，表明该分析方法是可行的。

PC斜拉桥的时变分析──确定性分析

通过对现有各种理论的研究和比较，认为Trost-Basant提出的“按龄期调整的有效模量法”是适合于PC斜拉桥分阶段施工特点的收缩徐变计算理论。根据该理论推导了新的增量形式的时变方程式，通过编程运算，可以将结构在各个阶段有节点力和位移的增量在一次运算中求出。同时还选用了目前广泛采用的多种收缩徐变模式进行了比较计算，认为BP-KX模式较适合于PC斜拉桥的时变分析。并通过对运营13年后的红水河铁路斜拉桥的实桥测试，将试验数据与计算结果进行分析比较，进一步论证了所提出的理论和方法的可行性，同时还得出了几点有意义的结论。

Opiate exposure increases arterial stiffness, advances vascular age and is an independent cardiovascular risk factor in females: A cross-sectional clinical study

Background: Whilst several studies have demonstrated poor cardiovascular health in opiate dependence, its role as a cardiovascular risk factor has not been considered. Methods: Pulse wave analysis was undertaken by radial arterial tonometry (SphygmoCor) in female control and opiate-dependent patients and compared to lifetime opiate use. Results: 222 opiate dependent women were compared to 175 controls. Opiate dependent patients were receiving treatment with buprenorphine (83.3%), methadone (13.5%), or naltrexone (3.2%). Non log transformed chronologic age (CA) for the two groups was 33.58 ± 0.57 (opiate) vs. 32.62 ± 0.96 (controls) years (mean ± S.E.M.;P = 0.39). Vascular Reference Age (RA) 39.30 ± 1.28, vs. 35.03 ± 1.41 the RA-CA difference (5.73 ± 1.02 vs. 2.41 ± 0.91) and the RA/CA ratio (1.16 ± 0.03 vs. 1.07 ± 0.02;all P < 0.02), and all measurements of central arterial stiffness (P < 0.02) were significantly worse for opiates compared to controls. When adjusted for CA, RA and central augmentation pressure and index were all worse by themselves and in interaction with CA (all P < 0.005). At 60 years the modelled RA’s were 83.79 and 67.52 years respectively. The opiate dose-duration interaction showed a dose-response effect with RA (P = 0.0033). After full adjustment for established cardiovascular risk factors, the dose-duration interaction remained significant (P = 10-6), was included in 10 other terms, and dose or duration was included in 15 other interactions. Conclusion: These data show that lifetime opiate use is significantly associated with increased arterial stiffness and vascular age and suggest a dose-response relationship. This relationship is robust and persists after full multivariate adjustment. These findings carry far-reaching implications for opiate-induced generalized acceleration of organismal ageing.

THERAPEUTIC EFFECT OF ABSTINENCE CAPSULE ON WITHDRAWAL SYMPTOMS OF HEROIN ADDICTS

435 heroin addicts were treated for 10 days to evaluate the therapeutic effectiveness ofabstinence capsule on heroin withdrawal symptoms and its main adverse actions.Lofexidine was applied in a control group of 48 addicts.The single blind method and somedetermination methods used internationally were employed to evaluate the therapeuticeffectiveness and adverse actions of the drugs.The results showed that the abstinence capsulehas better therapeutic effectiveness,with less adverse actions,wider safety range,longer timeof action and less cost than lofexidine.

穴位埋线对海洛因依赖者稽延性戒断症状的临床研究

目的:观察穴位埋线对海洛因依赖者稽延性戒断症状的临床疗效。方法:选取宁夏回族自治区某强制隔离戒毒所的稽延期海洛因依赖者30名,随机分成对照组(CG)和穴位埋线组(TG),每组各15例。对照组予通过强制隔离戒毒所日常基本管教项目进行干预,在此基础上穴位埋线组每2周进行穴位埋线治疗1次。采用高通量16SrDNA测序技术检测两组之间的差异肠道微生物群落结构,采用海洛因稽延性戒断症状评定量表评价对照组与穴位埋线组干预前后躯体症状、情绪症状、渴求症状和睡眠障碍的变化。结果:治疗2个月后,穴位埋线组海洛因稽延性戒断症状评分低于对照组,差异具有统计学意义(P<0.01)。与治疗前比较,两组治疗后chao、sobs指数降低,差异具有统计学意义(P<0.05),治疗后穴位埋线组OTU数目和simpson指数高于治疗前穴位埋线组和治疗后对照组。治疗后与对照组比较,穴位埋线组放线菌门,差异具有统计学意义(P<0.05)和变形菌门(P<0.01)相对丰度增加。与治疗前比较,治疗后穴位埋线组瘤胃球菌相对丰度增加,差异具有统计学意义(P<0.05);与治疗后对照组比较,穴位埋线组双歧杆菌属相对丰度增加。LEfSe分析可见,治疗后穴位埋线组相对丰度较大的菌群是Bacilli、乳杆菌科和乳杆菌属。结论:以养心安神、调和气血、补肾助阳及健脾和胃为治则的穴位埋线疗法通过穴位刺激可增加肠道有益菌、改善肠道功能,从而缓解神经系统异常出现的症状,最终得到减轻海洛因戒断症状的效果。

HTR1A、HTR1B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1A及1B受体(HTR1A、HTR1B)基因共9个单核苷酸多态性(SNPs)与海洛因依赖的关联性。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392例和401例健康对照为研究对象,提取外周血DNA,采用SNaPshot SNP基因分型技术对HTR1A和HTR1B基因共9个SNPs(rs878567、rs6449693、rs6294、rs1228814、rs1778258、rs4140535、rs6296、rs6297、rs6298)进行基因分型,采用SNPStats在线统计软件和广义多因子降维法(GMDR)分别进行海洛因依赖组与对照组各位点等位基因型和基因型频率分析及基因间交互分析。结果 rs878567 A等位基因(P=0.045,OR=0.77,95%CI:0.59~0.99)、rs6449693 G等位基因(P=0.040,OR=0.77,95%CI:0.59~0.99)、rs6296 C等位基因(P=0.022,OR=0.79,95%CI:0.65~0.97)及rs6298G等位基因(P=0.012,OR=0.78,95%CI:0.64~0.95)均是海洛因依赖的保护性因素;而携带rs6294 T等位基因的个体发生海洛因依赖的风险增高(P=0.028,OR=1.55,95%CI:1.04~2.29)。HTR1B基因TCGGCA单倍型(rs6297-rs6296-rs6298-rs1228814-rs1778258-rs4140535)在两组间差异具有统计学意义(P=0.014,OR=0.598,95%CI:0.395~0.905),是海洛因依赖的保护性因素。此外,rs878567-rs4140535-rs6296三阶交互模型是海洛因依赖的危险因素(P=0.006,OR=3.087,95%CI:0.952~10.016)。结论 HTR1A和HTR1B基因共5个单核苷酸多态性位点与人群海洛因依赖的易感性存在一定关联性,且二者可能通过交互作用影响大脑奖赏效应的调节,进而参与海洛因依赖的形成。

Traditional Chinese Medicine-facilitated switch from methadone to buprenorphine-naloxone for treatment of heroin dependence: a case report

The switch from methadone to buprenorphine-naloxone for individuals with heroin dependence is associated with several obstacles and challenges.Such patients may experience discomfort from discontinuing methadone, precipitated withdrawal symptoms induced by buprenorphine-naloxone,and poor psychosocial adjustments such as anticipatory anxiety regarding severe opioid withdrawal.We herein describe a 46-year-old man with a history of heroin dependence who underwent Traditional Chinese Medicine(TCM)-facilitated switching from methadone to buprenorphine-naloxone. No precipitated withdrawal was induced by buprenorphine-naloxone. The drug-switching process was successful and smooth. He maintained abstinence from heroin for the following year. In this case, we applied TCM for enhancement of methadone metabolism and detoxification, analgesic effects, and anxiolytic and hypnotic effects during the drug switch. We observed that TCM effectively facilitated the switch from methadone to buprenorphine-naloxone in our case. Further studies regarding TCM-facilitated treatment for heroin dependence should be conducted.

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.

美沙酮维持治疗对海洛因依赖者大脑度中心性影响的静息态fMRI研究

目的探索美沙酮维持治疗(methadone maintenance treatment,MMT)对海洛因依赖(heroin dependence,HD)患者大脑拓扑特性度中心性(degree centrality,DC)的影响及其与心理行为学的相关性。材料与方法回顾性分析2016年1月至2017年12月于西安市灞桥区美沙酮门诊招募的41名正在接受MMT的HD患者,采集静息态功能磁共振成像(functional magnetic resonance imaging,fMRI)数据,评估稽延性戒断症状与渴求评分,纵向随访一年。对影像数据进行DC分析,并采用配对样本t检验进行纵向比较,差异脑区与心理学指标进行相关分析。结果HD患者入组时与MMT一年后稽延性戒断症状评分差异存在统计学意义(Z=3.004,P=0.003),渴求评分差异无统计学意义(Z=0.872,P=0.383)。与基线相比,HD患者经过MMT一年后,双侧丘脑、尾状核、壳核与左侧苍白球的DC降低;右侧舌回与距状回的DC值升高(Gaussian random field校正,单体素水平P<0.001,团块体素水平P<0.01,团块体素>95)。双侧尾状核及左侧苍白球DC值与戒断症状呈负相关性(r=-0.417,P=0.030;r=-0.392,P=0.043;r=-0.383,P=0.049),双侧壳核及左侧苍白球DC值的变化量与渴求的变化量呈正相关性(r=0.410,P=0.008;r=0.332,P=0.034;r=0.395,P=0.011)。结论美沙酮可能通过降低HD患者纹状体在成瘾奖赏脑网络中的中心性,从而调节HD患者戒毒后的稽延性戒断症状与心理渴求;同时可能抑制了冲动性,增强了视觉核心脑区的活动。该研究结果可以为美沙酮对HD患者治疗的神经机制提供影像学依据。

Influence of Acupuncture on Sleep Disorders and Anxiety in Patients with Heroin Dependence

Objective： To observe the influence of acupuncture on sleep disorders and anxiety in patients with heroin dependence. Methods： Sixty-two male patients with heroin dependence were divided into two groups by random number table. Thirty-five cases in the acupuncture group were treated by puncturing Baihui （GV 20）, Neiguan （PC 6）, and Shenmen （HT 7） and moxibustion at Zusanli （ST 36）. Twenty-seven cases in the control group did not receive any therapeutic measures. The therapeutic effects were summarized after observation of 8 weeks. Results： After treatment, the global scores and standard scores of anxiety declined in comparison with those before the treatment in both two groups, but there was statistical difference only in the acupuncture group （P〈0.05）. There were no statistical differences in the global score and the standard score of anxiety between the two groups, but the standard scores in the acupuncture group reached the normal level. After treatment, only the sleep latency was obviously improved in the control group （P〈0.05）. The syndromes of sleep disorder were improved noticeable in the acupuncture group （P〈0.05）, and the actual sleep time was improved better than those in the control group （P〈0.05）, and PSQI global scores decreased below the normal level. Conclusion： Acupuncture has the effects to improve sleep disorders and anxious emotion in the patients with heroin dependence.

海洛因成瘾者复吸相关因素的临床分析及预防复发的探讨

目的 :调查分析海洛因成瘾复吸者的复吸相关因素 ,为降低复吸率提供背景资料和依据。方法 :采用自编“吸毒人员复吸相关因素调查表”调查 2 14例海洛因复吸者。结果 :在复吸相关因素中 ,以社会支持不足心理行为障碍和应激情境最重要 ,肯定回答率 ,分别为 5 3 .1%、3 5 .0 %和 2 7.6% ,药理特性及可获得性、稽延性戒断症状次之 ,肯定回答率分别为 2 2 .2 %和 2 6.4 %。结论 :复吸除与药物本身的药理特性和可获得性有关外 ,与社会支持不足 ,毒友团伙的引诱和各种心理行为障碍未得及时解决亦相关 ,社会心理应激因素是造成复吸的主要原因。建议对吸毒者不要一味地采取歧视、惩罚等负性态度 ,缩短强制戒毒时间 ,同时健全吸毒人员社区康复服务机构 ,并纳入精神卫生服务网络体系中。戒毒工作需要精神卫生工作者、警务人员及基层社区工作者协同参与 。

海洛因依赖性人格概念的建构及其与心理健康的关系

目的:了解海洛因依赖性人格的概念结构,建立海洛因依赖性人格量表。方法:对10 5名海洛因戒除者的海洛因依赖性人格问卷的测试数据进行验证性因素分析。结果:(1)海洛因依赖性人格由海洛因渴求感和戒除效能感两个维度构成,二维模型对样本数据的拟合度较好;(2 )海洛因渴求感α=0 .86 6 ,戒断效能感α=0 . 92 3,所有项目与所属因素因子分的相关系数在0. 6 81- 0 . 876之间,P <0 .0 0 1,两个分量表的相关系数r =- 0 4 4 2 ,P <0 . 0 0 1;(3)海洛因渴求感和戒除效能感与自尊、孤独、抑郁的相关系数的绝对值在0 . 2 2 1- 0. 5 11之间,达到显著性水平;回归分析的结果显示,戒断效能感可解释自尊、孤独和抑郁14 . 4 %、10 . 8%和2 6 . 2 %的变异。结论:海洛因依赖性人格的概念的构想合理,其量表具有良好的项目区分度、内部一致性信度和效度。

海洛因依赖者某些免疫功能指标的初步观察

本文检测分析了30例海洛因依赖者基础免疫水平,结果表明:海洛因对体液免疫和细胞免疫功能均有明显损害作用.海洛因依赖者血清IgA、IgG、IgM 含量低于正常对照组,尤以IgA 为甚(P<0.01);补体C3和C4降低不明显(P>0.05);细胞免疫功能受损显著:与对照组相比T 淋巴细胞转化试验(LTT)、CD3、CD4明显降低(P<0.001或P<0.05)、CD8明显增高(P<0.001)、CD4/CD8比值降低(P<0.001);提示细胞免疫功能处于明显缺陷状态。著者认为,其机制可能与海洛因对胸腺——下丘脑——垂体——肾上腺轴的抑制效应和免疫细胞的直接毒害作用有关。

海洛因依赖者的乙型肝炎和丙型肝炎感染

目的：了解海洛因依赖者的ＨＢＶ和ＨＣＶ感染情况，探讨其与感染有关的行为特征。方法：采用ＥＬＩＳＡ法检测了１５２例海洛因依赖者和５６例对照者的乙型肝炎和丙型肝炎感染情况，并调查了海洛因依赖者的成瘾史、不洁注射史、性伙伴情况等与肝炎传播有关的行为特征。发现海洛因依赖组与对照组的ＨＢＶ、ＨＣＶ感染率、总感染率、ＨＢＶ感染率、ＨＣＶ的感染率、ＨＢＶ和ＨＣＶ的重叠感染率依次分别为４６７％、２８３％、２７６％、９２％与１６７％、１１１％、５６％、０％。ＨＢＶ和ＨＣＶ的感染与海洛因依赖者的静脉注射、不洁注射史、成瘾时间及性别有关。提出在海洛因依赖者中预防ＨＢＶ、ＨＣＶ感染、减少药物滥用危害的重要性。

环境线索诱导海洛因依赖者心理渴求的SPECT研究

目的 :研究与海洛因相关的环境线索诱导急性脱毒后海洛因依赖者的心理渴求及其局部脑血流灌注的变化特征。方法 :选择脱毒治疗一个月后海洛因依赖者 ,给于与海洛因相关的环境刺激 (暴露 ) 15分钟 ,在海洛因环境暴露前后分别评定心理渴求量表和汉米尔顿焦虑量表 ,同时采用单光子发射计算机断层扫描 (SPECT)测量局部脑血流灌注 (rBCF)的变化。结果 :暴露海洛因相关的环境可增加病人对药物的心理渴求 :1)使脱毒海洛因依赖者的心理渴求量表评分增加 ,与暴露前相比差异有显著性 (t =3 2 1P <0 0 5 ) ;2 )海洛因相关的环境刺激可以增加病人的焦虑情绪 ,表现为汉米尔顿焦虑量表总评分增高 ,(t =3 1,P <0 0 1)特别是躯体焦虑因子评分增高更为明显 (t =2 98,P <0 0 1) ;3 )海洛因的环境刺激明显增加额叶 ,颞叶皮层及杏仁核等脑区的局部脑血流 ,而其他脑区如顶叶、枕叶、扣带回及基底节等区域的脑血流灌注则无明显的变化。结论 :海洛因相关的环境可以诱导吸毒者对海洛因的心理渴求 ,是脱毒后发生复吸的主要因素之一 ,额叶、颞叶皮层及杏仁核等脑区参与了环境线索诱导复吸的神经生物过程。阻断药物相关的环境线索的刺激可以作为预防吸毒者脱毒后的再次复吸行为的手段之一。

云南、四川两省海洛因依赖者脱毒治疗方法调查

目的 :调查云南、四川两省海洛因依赖者脱毒治疗的方法。方法 :采用中国药物依赖性研究所设计的问卷在两省的 11个地、市、县药物依赖治疗机构调查接受戒毒治疗的海洛因依赖者。问卷内容主要包括吸毒者的人口学特征、吸毒者脱毒治疗的方法及相关问题。结果 :在 16 80份有效问卷中女性占 2 2 3% ;男性占 77 7%。其中接受过美沙酮或丁丙诺啡替代治疗的分别占 6 0 1% ( 890 14 82 ) ,4 0 % ( 5 9 14 83) ;中药脱毒治疗的占 2 3 6 % ( 35 0 14 82 ) ;可乐定递减治疗占 2 6 % ( 38 14 82 ) ;其它药物治疗的占 7 7% ( 114 14 77) ;非药物治疗的占 2 7 0 % ( 4 0 0 14 79)。结论 :海洛因依赖者采用的脱毒治疗方法以美沙酮治疗为主 ,但接受其它脱毒治疗方法的也占相当的比例 ,建议应加强对脱毒治疗方法效果的追踪调查 ,为有效延长操守时间。

海洛因成瘾复吸动物模型的建立

目的 :模仿人类吸毒→依赖 (成瘾 )→脱毒治疗→复吸→再依赖→再脱毒→再复吸的方式 ,建立海洛因成瘾复吸动物模型 ,为深入研究海洛因成瘾复吸患者神经生物学、行为学、神经药理学奠定基础。方法 :采用递增法人为地给动物注射海洛因造成动物成瘾 ,用美沙酮—丁丙诺啡—可乐定脱毒治疗。尔后再投用海洛因造成复吸、成瘾、再治疗→再复吸的方式处理 ,设对照组和模型组 ,观察动物的行为 ,神经系统形态学光镜、电镜下的组织变化 ,大脑部分递质的变化 ,以证实模型的建立。结果 :动物成瘾期 ,催瘾试验阳性 ,戒断症状明显 ;星形胶质细胞及神经元不同程度受损 ,中枢神经去甲肾上腺素、多巴胺、5 -羟色胺、5 -羟吲哚乙酸均明显升高。结论 :模仿人类吸毒→依赖 (成瘾 )→脱毒治疗→复吸→再依赖→再脱毒→再复吸的方式 ,建立海洛因成瘾复吸动物模型 ,对研究药物依赖状况下中枢神经的功能。

海洛因稽延性戒断症状评定量表的初步编制

目的：复吸是海洛因依赖脱毒后的一个关键问题，稽延性戒断症状在引发复吸中具有重要的作用，有必要对其进行规范化评定。方法：分别调查了１３２名美沙酮递减脱毒及４３名未给予任何药物自然戒断脱毒的海洛因依赖住院治疗者，对脱毒后的２０个症状进行观察，从中选出８项稽延性戒断症状项目，编制成海洛因稽延性戒断症状评定工具。结果：初步编制了海洛因稽延性戒断症状评定量表，它将有助于海洛因稽延性戒断症状的研究。