Chen I-Chun, Lee Ming-Huei, Chen Wei-Chih, Hu Tsung-Ching, Lin Hsiu-Ying
Department of Psychiatry, Taichung General Veterans Hospital, Taichung, Taiwan.
Department of Urology, Feng-Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
Low Urin Tract Symptoms. 2018 Sep;10(3):281-286. doi: 10.1111/luts.12178. Epub 2017 Jul 13.
This study investigated the risk factors of ketamine associated-lower urinary tract symptoms (LUTS), such as duration of use, dosage of ketamine, co-occurring substance use of other psychoactive drugs, comorbidities, and depression.
This study was a cross-sectional survey. LUTS was assessed with the O'Leary symptom and problem index (OSPI) scores. We included the comorbidities of interstitial cystitis/painful bladder syndrome (IC/PBS) as comorbid factors. Depression was evaluated based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). Duration of use, dosage of ketamine and the OSPI scores were subjected to log transformation because of the skewed distribution.
Among 143 participating ketamine users, 25 (17.5%) had LUTS. Duration of ketamine use was significantly positively correlated with OSPI scores (adjusted β [95% CI], 0.21 [0.06-0.35] in log-log model), which equaled a 10% increase in months of ketamine-use increased OSPI scores by 2.02 %. Female and depression were significantly associated OSPI scores (adjusted β [95% CI], 0.20 [0.03-0.37], 0.49 [0.29-0.70], respectively in the log-linear model), with OSPI scores being 1.22 times higher in female, and 1.63 times higher in ketamine users with depression. Dosage of use was not significantly associated with OSPI scores (adjusted β [95% CI], 0.04 [-0.12 to 0.20], P = 0.64 in log-log model), likewise with comorbid diseases (adjusted β [95% CI], 0.07 [-0.08 to 0.21], P = 0.36 in log-linear model).
Depression and longer duration of exposure to ketamine are significantly associated with the development of LUTS among ketamine users. Early evaluation and intervention of depression should be considered in patients of ketamine-associated LUTS.
本研究调查了氯胺酮相关下尿路症状（LUTS）的风险因素，如使用时长、氯胺酮剂量、同时使用其他精神活性药物、合并症和抑郁症。
本研究为横断面调查。采用奥利里症状与问题指数（OSPI）评分评估LUTS。我们将间质性膀胱炎/疼痛性膀胱综合征（IC/PBS）的合并症作为合并因素。根据《精神疾病诊断与统计手册》第五版（DSM-5）评估抑郁症。由于分布呈偏态，对使用时长、氯胺酮剂量和OSPI评分进行对数转换。
在143名参与研究的氯胺酮使用者中，25人（17.5%）有LUTS。氯胺酮使用时长与OSPI评分显著正相关（对数-对数模型中调整后的β[95%置信区间]为0.21[0.06-0.35]），即氯胺酮使用月数增加10%，OSPI评分增加2.02%。女性和抑郁症与OSPI评分显著相关（对数线性模型中调整后的β[95%置信区间]分别为0.20[0.03-0.37]、0.49[0.29-0.70]），女性的OSPI评分高1.22倍，患抑郁症的氯胺酮使用者的OSPI评分高1.63倍。使用剂量与OSPI评分无显著相关性（对数-对数模型中调整后的β[95%置信区间]为0.04[-0.12至0.20]，P = 0.64），合并症同样如此（对数线性模型中调整后的β[95%置信区间]为0.07[-0.08至0.21]，P = 0.36）。
抑郁症和较长的氯胺酮暴露时长与氯胺酮使用者中LUTS的发生显著相关。对于氯胺酮相关LUTS患者，应考虑对抑郁症进行早期评估和干预。
