School of Psychiatry and Clinical Neurosciences, University of Western Australia, 39 Gladstone Rd, Highgate Hill, Brisbane, QLD, Australia.
Cardiovasc Toxicol. 2013 Mar;13(1):55-67. doi: 10.1007/s12012-012-9186-7.
The central cardiovascular impacts of clinical opiate withdrawal have not been explored in detail. Pulse Wave Analysis (SphygmoCor) was conducted in healthy controls and opiate-dependent populations. A total of 1,294 patients (69.2 % male) were studied in quintuplicate on 2,089 occasions. Four groups were studied: control (N = 576), buprenorphine stabilized (N = 592), withdrawal (N = 112) and severe withdrawal (N = 14). Control patients were younger than the other groups (29.96 ± 0.45 years v. 32.53 ± 0.74-39.28 ± 3.86) but had similar sex ratios. Multiple regression was used to correct for the effects of age, and significant exacerbations were found in withdrawal in the vascular age (RA), augmentation index, subendocardial perfusion ratio (SEVR <100; R.R. 2.07 95 % C.I. 1.17-3.68, P = 0.02) and central systolic pressure both as factors themselves and in interactions with age (all P < 0.01). The elevation of modelled RA at 60 years was from 69.66 in controls to 97.54 in withdrawal (40.02 %). The effects on RA were found in both sexes and confirmed on longitudinal analysis. The elevation of RA in withdrawal was most marked after 40 years of age (P = 0.027). These results show increased vascular stiffness and cardiovascular age but reduced subendocardial perfusion in opiate withdrawal. Given the daily recurrent nature of withdrawal, these effects are likely cumulative.
尚未详细探讨临床阿片类药物戒断的中心心血管影响。对健康对照者和阿片类药物依赖人群进行了脉搏波分析（SphygmoCor）。共在 2089 次就诊时对 1294 例患者（69.2%为男性）进行了五倍重复研究。研究了 4 组患者：对照组（N=576）、丁丙诺啡稳定组（N=592）、戒断组（N=112）和严重戒断组（N=14）。对照组患者比其他组年轻（29.96±0.45 岁比 32.53±0.74-39.28±3.86），但性别比例相似。使用多元回归校正年龄影响，发现戒断组血管年龄（RA）、增强指数、心内膜下灌注比（SEVR<100；RR 2.07 95%CI 1.17-3.68，P=0.02）和中心收缩压本身以及与年龄的相互作用都显著恶化。在 60 岁时，模拟 RA 的升高幅度从对照组的 69.66 增加到戒断组的 97.54（40.02%）。这些影响在两性中均存在，并在纵向分析中得到证实。RA 在戒断中的升高在 40 岁以后最为明显（P=0.027）。这些结果表明阿片类药物戒断后血管僵硬和心血管年龄增加，但心内膜下灌注减少。鉴于戒断的日常反复发作性质，这些影响可能是累积的。
