Jiang Haifeng, Hillhouse Maureen, Du Jiang, Pan Shujun, Alfonso Ang, Wang Jun, Zhou Zhirong, Yuan Weijun, Ling Walter, Zhao Min
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
Department of Psychiatry, Integrated Substance Abuse Program, University of California at Los Angeles, Los Angeles, CA, 90025, USA.
Neurosci Bull. 2016 Dec;32(6):538-544. doi: 10.1007/s12264-016-0059-0. Epub 2016 Sep 10.
The purpose of this study was to investigate the blood levels of methadone in participants receiving methadone for the treatment of opioid dependence. After stabilization on methadone for four weeks, blood samples from 95 participants were collected between treatment weeks 4 and 12, before and after receiving doses of methadone, and its blood levels were measured. A multiple linear regression model was used to examine the association between methadone blood levels and the outcomes of methadone maintenance treatment (MMT). Outcome differences between participants who had high (≥2) or low (<2) peak-to-trough ratios were also compared using an independent sample t-test. The blood level of methadone was not correlated with the clinical outcome of MMT with the moderate range of doses given. However, the retention of patients who had a free peak-to-trough ratio >2 was significantly poorer than those whose ratio was <2. Thus, monitoring plasma methadone levels is unlikely to be effective for guiding dosing decisions in situations where compliance with MMT is already very high or when the methadone dose is no longer the dominant factor in determining the clinical outcome. However, monitoring plasma methadone levels is still helpful for guiding the dosage for patients with a rapid metabolism.
本研究的目的是调查接受美沙酮治疗阿片类药物依赖的参与者的美沙酮血药浓度。在美沙酮稳定治疗四周后，收集了95名参与者在治疗第4周和第12周之间、接受美沙酮剂量前后的血样，并测量了其血药浓度。采用多元线性回归模型来检验美沙酮血药浓度与美沙酮维持治疗（MMT）结果之间的关联。还使用独立样本t检验比较了峰谷比高（≥2）或低（<2）的参与者之间的结果差异。在给予中等剂量的情况下，美沙酮血药浓度与MMT的临床结果无关。然而，自由峰谷比>2的患者的留存率明显低于峰谷比<2的患者。因此，在MMT依从性已经很高或美沙酮剂量不再是决定临床结果的主要因素的情况下，监测血浆美沙酮水平不太可能有效地指导剂量决策。然而，监测血浆美沙酮水平对于指导代谢迅速的患者的剂量仍有帮助。
