在纳洛酮诱发戒断期间，瞳孔直径与其他阿片类药物戒断指标之间的关系。
The relationship between pupil diameter and other measures of opioid withdrawal during naloxone precipitated withdrawal.
机构信息
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
出版信息
Drug Alcohol Depend. 2019 Sep 1;202:111-114. doi: 10.1016/j.drugalcdep.2019.05.010. Epub 2019 Jul 16.
BACKGROUND
Understanding mechanisms of physiological opioid withdrawal symptoms can inform treatment strategies. This secondary analysis evaluated the association between mydriasis (dilated pupils), a commonly-assessed opioid withdrawal metric, with self- and observer-rated opioid withdrawal severity.
METHOD
Ninety-five participants with opioid physical dependence were stabilized with morphine before receiving an injection of the opioid antagonist naloxone to precipitate withdrawal. Pupil diameter, the Subjective Opiate Withdrawal Scale (SOWS), and the Clinical Opiate Withdrawal Scale (COWS) were collected at baseline and in 15-minute intervals for 120 min following naloxone administration. Pearson product-moment correlations and linear regressions characterized the relationships between pupil measurements (baseline and peak naloxone-induced) and self- and observer-rated measures of withdrawal. Repeated-measures ANOVAs tested whether self and observer-rated withdrawal severity corresponded to unique patterns in pupil changes.
RESULTS
Baseline pupil diameter significantly correlated with SOWS and COWS peak scores. Peak naloxone-induced pupil diameter significantly correlated with SOWS scores only. Peak changes in pupil from baseline did not correspond to peak changes in self- and observer-rated withdrawal scales.
CONCLUSIONS
This study suggests that pupil diameter measurements were more closely associated with acute opioid withdrawal severity than changes in pupil diameter. Prospective research examining the mechanisms underlying the relationship between pupil diameter and opioid withdrawal severity are warranted.
背景
了解生理阿片类戒断症状的机制可以为治疗策略提供信息。这项二次分析评估了瞳孔散大（瞳孔扩大）与自我和观察者评估的阿片类戒断严重程度之间的关系，瞳孔散大是一种常用的阿片类戒断评估指标。
方法
95 名有阿片类物质身体依赖的参与者在接受阿片类拮抗剂纳洛酮注射以引发戒断之前，先用吗啡稳定病情。在纳洛酮给药后 120 分钟内，以 15 分钟为间隔，采集瞳孔直径、主观阿片戒断量表（SOWS）和临床阿片戒断量表（COWS）的数据。皮尔逊积差相关和线性回归分析用于描述瞳孔测量值（基线和纳洛酮诱导的峰值）与自我和观察者评估的戒断程度之间的关系。重复测量方差分析测试自我和观察者评估的戒断严重程度是否对应于瞳孔变化的独特模式。
结果
基线瞳孔直径与 SOWS 和 COWS 峰值评分显著相关。纳洛酮诱导的瞳孔直径峰值仅与 SOWS 评分显著相关。从基线到峰值的瞳孔变化与自我和观察者评估的戒断量表的峰值变化不对应。
结论
这项研究表明，瞳孔直径测量值与急性阿片类戒断严重程度的相关性高于瞳孔直径的变化。需要进行前瞻性研究，以探讨瞳孔直径与阿片类戒断严重程度之间关系的潜在机制。
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