Methaquaiona a Or. Jekyll and Mr. Hyde

Cocaine is widely recognized as one of the most frequently used illicit drugs in use today. This review examines animal and clinical data concerning in utero cocaine exposure and its effect on the development of the fetus and newborn infant.     

吗啡依赖和戒断大鼠脊髓内NA能神经元变化的研究

目的探讨慢性吗啡处理及戒断后大鼠脊髓内NA能神经元的形态变化.方法24只雄性SD大鼠随机分为吗啡依赖组、吗啡戒断组和生理盐水对照组,每组8只.依赖组大鼠以腹腔注射吗啡方法建立吗啡依赖模型.戒断组大鼠在依赖模型建立后于腹腔注射纳洛酮5 mg/kg诱导戒断症状,对照组大鼠注射等量生理盐水.注射24 h后取脑和脊髓作冰冻切片.利用免疫组化方法检测各组大鼠脊髓及LC内NA能神经元的变化.结果正常组LC内DBH阳性细胞数为(98±17),吗啡依赖组和戒断组LC内DBH阳性细胞数分别为(212±20)和(229±27),明显高于正常组(P＜0.01),但平均灰度值无明显差异.慢性吗啡处理后脊髓前角DBH阳性神经元数量增多,染色加深,后角和侧角新增加大量阳性神经元,吗啡依赖组和戒断组DBH阳性神经元增加具有极显著意义(P＜0.01).结论慢性吗啡处理和戒断引起LC和脊髓内NA能神经元增多,提示NA与吗啡依赖和戒断的形成有关,其可能是吗啡依赖及戒断的分子机制之一.     

Imaging brain mu-opioid receptors in abstinent cocaine users: time course and relation to cocaine craving.

BACKGROUND: Cocaine treatment upregulates brain mu-opioid receptors (mOR) in animals. Human data regarding this phenomenon are limited. We previously used positron emission tomography (PET) with [11C]-carfentanil to show increased mOR binding in brain regions of 10 cocaine-dependent men after 1 and 28 days of abstinence. METHODS: Regional brain mOR binding potential (BP) was measured with [11C]carfentanil PET scanning in 17 cocaine users over 12 weeks of abstinence on a research ward and in 16 healthy control subjects. RESULTS: Mu-opioid receptor BP was increased in the frontal, anterior cingulate, and lateral temporal cortex after 1 day of abstinence. Mu-opioid receptor BP remained elevated in the first two regions after 1 week and in the anterior cingulate and anterior frontal cortex after 12 weeks. Increased binding in some regions at 1 day and 1 week was positively correlated with self-reported cocaine craving. Mu-opioid receptor BP was significantly correlated with percentage of days with cocaine use and amount of cocaine used per day of use during the 2 weeks before admission and with urine benzoylecgonine concentration at the first PET scan. CONCLUSIONS: These results suggest that chronic cocaine use influences endogenous opioid systems in the human brain and might explain mechanisms of cocaine craving and reinforcement.     

Serum ferritin and transferrin saturation in patients with chronic alcoholic and non-alcoholic liver diseases

Abstract. Objectives. To compare serum ferritin concentration and transferrin saturation in patients with alcoholic and non-alcoholic chronic liver diseases. Design. Concecutive patients with liver diseases. Setting. The department of internal medicine in a teaching hospital. Subjects. Three hundred and twelve patients with different liver diseases concecutively admitted between 1987 and 1992. Interventions. None. Main outcome measures. Fasting serum iron, transferrin and ferritin. Results. Serum ferritin was increased above 200 μg L^?1 in all 18 patients with haemochromatosis (range 310–6500 μg L^?1), in 64 of 111 alcoholics (58%) and in 30 of 137 (22%) with chronic non-alcoholic liver diseases (P < 0.01). Twelve of 111 alcoholics (11%) had serum ferritin above 1000 μg L^?1 compared with one of 137 (0.7%) with chronic non-alcoholic liver diseases. In 13 alcoholics who abstained after admission, serum ferritin decreased from 1483 μg L¹ ± 1134 to 388 μg L^?1 ± 237 (P < 0.001) after 1 1/2 to 6 weeks. The transferrin saturation was increased above 62% in 13 of 18 patients (72%) with haemochromatosis, in 16 of 105 alcoholics (15.2%) and in three of 132 (2.3%) with chronic non-alcoholic liver disease (P < 0.01). Conclusion. Serum ferritin is more frequently elevated in abusing patients with alcoholic liver disease than in patients with other chronic liver diseases such as autoimmune liver diseases and hepatitis C. Because serum ferritin decreases rapidly during abstinence, the measurement of ferritin for the detection of haemochromatosis in patients abusing alcohol should be postponed until the patients are abstaining. Most of the patients with increased serum ferritin have normal transferrin saturation values which can be used to separate them from haemochromatosis.     

苯巴比妥致大鼠身体依赖性实验

本文采用苯巴比妥掺食法，连续给药８０ｄ，造成大鼠身体依赖性模型。自然戒断后第１４ｈ，开始出现戒断症状，并逐渐加重，第１６ｈ出现震颤、抽搐等症状，第２４ｈ出现阵发自发性惊厥，部分大鼠因惊厥而死亡。第６２ｈ症状完全自然消退。与苯巴比妥等药效剂量的安定可以部分抑制戒断症状。用荧光法对大鼠脑内的单胺类递质的测定表明：５—ＨＴ、５—ＨＩＡＡ，ＮＡ和ＤＡ的含量在依赖状态或是戒断后第７２ｈ与对照组比较，无明显的差异。用放射受体法测定苯巴比妥依赖及戒断状态大鼠脑内ＧＡＢＡ的含量，结果表明：二者ＧＡＢＡ值明显地低于空白对照组，安定替代组大鼠脑内ＧＡＢＡ含量亦显著地低于对照组。     

海洛因依赖者血糖变化

本组研究通过观察戒毒人员在非戒断反应状态时空腹血糖（ＦＢＳ）、餐后２ｈ血糖（ＰＰＢＳ）和戒断反应出现时的血糖水平变化，并与正常人ＦＢＳ、ＰＰＢＳ及任意血糖值比较，发现戒断反应出现前、后血糖有明显波动（Ｐ＜０．０１），其特点为戒断反应出现时血糖迅速升高。揭示当时很可能有下丘脑－垂体－肾上腺轴功能亢进及与交感胺类物质分泌迅速增加有关。     

深部脑刺激戒断阿片类药物精神依赖1例临床报道(附3个月随访结果)

目的在立体定向射频毁损手术的研究基础上，进行了1例深部脑刺激(deep brain stimulation，DBS)戒断阿片类药物精神依赖手术，探讨一种既能起到有效治疗作用，而又减少副损伤的外科治疗方法。方法药物依赖患者，男性，24岁，吸食海洛因等多种毒品成瘾5年，反复戒毒5次无效。在阿片脱毒术脱毒后，行双侧伏隔核DBS电极植入术，立体定向MRI定位，植入Medtronic 3387刺激电极及脉冲发生器。术后定期进行疗效随访，以及副作用、心理学量表和症状量表等评估。结果患者术后即停止吸毒，通过3个月的临床观察，至今无复吸现象。临床证实该方法较射频毁损方法微刨、副反应小，心理学量表(WMS、WEIS-RC和MMPI)评估未发现有记忆、智力和人格等方面影响。术后患者饮食较术前明显好转，体重增加，吸烟量明显减少；症状自评量表(SCL90、SAS和SDS)评估提示多因素均有明显改善。结论应用DBS外科方法戒断阿片类药物精神依赖，取得短期满意疗效。     

双侧扣带回毁损术治疗海洛因精神依赖

目的探讨双侧扣带回毁损术治疗海洛因精神依赖的临床疗效和可能的作用机制。方法对4例海洛因成瘾病人术前行美沙酮脱毒治疗;之后采用MRI定位立体定向扣带回毁损术,在双侧扣带回前中1/3交界处射频制造毁损灶;术后进行康复治疗和帮助其回归社会。结果均顺利接受了治疗全过程,无明显并发症。随访半年,2例病人无复吸;1例术后1个月内偶有复吸,其后无复吸;另1例病人术后4个月起复吸。操守较好者焦虑、抑郁等精神症状明显缓解,海洛因渴求程度明显减轻。结论双侧扣带回毁损术治疗海洛因精神依赖,安全、近期有效;可能与精神症状的缓解有关,长期效果有待随访。     

酒精所致精神障碍42例临床分析

1992～1995年四年间收治酒精所致精神障碍42例，住院比逐年升高；均为男性．低文化者66．7％，有遗传倾向者54．8％，有戒断症状者38．1％，全部病例均有精神病理性症状，半数患者有神经系统的损害和躯体合并症，42．8％的患者表现人格衰退，社会功能受损，近1／4的患者有自杀行为．     

易解宁治疗阿片类药物依赖的临床研究

本文对６４例海洛因成瘾者使用中药易解宁口服液和盐酸丁丙诺啡对照治疗１０天，对比两者在抗戒断症状、对下丘脑－垂体－性腺轴功能指标影响方面的作用强度。结果表明中药易解宁口服液控制戒断症状的逐日递减总分、恢复紊乱的性激素功能方面明显优于丁丙诺啡（Ｐ〈０．０１）。