糖皮质激素对美沙酮抑制海洛因依赖者戒断反应的影响

目的··:观察海洛因依赖者血浆 β—内啡肽、ACTH及皮质醇在治疗前后的变化 ,戒断反应与应激反应的关系 ,并探讨糖皮质激素对美沙酮抑制海洛因依赖者戒断反应的影响。方法··:对海洛因依赖者脱毒治疗前后戒断症状分值进行评分 ,治疗前后血浆β—内啡肽、ACTH及皮质醇进行放免测定。结果··:治疗前 ,血浆ACTH、皮质醇水平升高且超过正常值 ,ACTH与戒断评分呈正相关。使用脱毒药物治疗后 ,各组ACTH、皮质醇水平均呈下降趋势 ,且血浆皮质醇水平与戒断症状控制程度相关。1/3量美沙酮配伍强的松60mg·d -1,控制戒断症状的效果不仅优于单用1/3量美沙酮组(P<0.05) ,而且与全量美沙酮组疗效接近(P>0.05)。结论··:海洛因依赖者戒断反应伴有应激反应并与之呈正相关 ,糖皮质激素有协同美沙酮控制海洛因依赖者戒断症状的作用 ,可提高美沙酮的疗效 ,减少美沙酮的用量。

EFFICACY OF GLUCOCORTICOIDS ON DETOXIFICATION WITH METHADONE IN HEROIN ABUSERS

Objective : To explore the relationship between abstinence reaction and stress reaction ; the effect of glucocorticoids on the detoxification of heroin abusers with methadone. Method: Abstinence syndrome scores, plasma β-endorphin, ACTH and cortisol of heroin abusers were determined before and after detoxification.Result: The concentration of plasma ACTH and cortisol was higher compared with the normal value when detoxification started. Afterwards, the concentrations in all groups declined accompanied by the declination of abstinence syndrome scores when drugs for detoxification were administered. Methadone of 1/3 dose (0.33 mg·d-1 on the first day) together with prednisone (60 mg·d-1) could effectively control the abstinence syndromes, its efficacy was not only better than that in Group A(methadone of 1/3 dose)(P<0.05), but also similar to that of Group C(methadone of full dose,1 mg.d-1 on the first day)(P<0.05).Conclusion: Stress reaction is positively related to abstinence reaction; glucocorticoids has a cooperative suppressive action on abstinence reaction; it may improve the detoxification efficacy of methadone.