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谨慎看待大麻二酚(CBD)在风湿病学治疗中的应用。

Cautious Hope for Cannabidiol (CBD) in Rheumatology Care.

机构信息

McGill University Health Centre, Montreal, Quebec, Canada.

University of Michigan Medical School, Ann Arbor.

出版信息

Arthritis Care Res (Hoboken). 2023 Jun;75(6):1371-1375. doi: 10.1002/acr.24176. Epub 2023 Mar 14.

DOI:10.1002/acr.24176
PMID:32144889
Abstract

Cannabidiol (CBD), a major metabolite of Cannabis sativa, is popularized as a medicinal product, with potential for analgesic, antiinflammatory, and antioxidant effects. CBD may hold promise as a treatment in rheumatic diseases, but evidence to date remains preclinical. Preclinical effects on pain and inflammation is encouraging, but clinical study is lacking, with only a single study in knee osteoarthritis reporting a promising effect on symptoms. CBD products are freely available over the counter and marketed as food supplements or wellness products. The World Health Organization has identified pure CBD as safe and without abuse potential, but products are not subject to drug regulatory standards, leading to inconsistency in manufacturing practices and quality of products. Not only have molecular concentrations of CBD been identified as inaccurate, but concerns exist regarding contaminants, including heavy metals, pesticides, microbes, and mycotoxins, as well as added tetrahydrocannabinol. Drug-drug interactions pose a potential risk due to metabolism via the cytochrome P450 enzyme pathway. Patients wishing to use CBD should obtain a product with certification of Good Manufacturing Practices, initiate treatment with a nighttime low dose, and have defined outcome goals within a reasonable time frame. Treatments should not be managed by nonmedical dispensary personnel. The hope that CBD may be a useful therapy must be substantiated by sound scientific study.

摘要

大麻二酚(CBD)是大麻的主要代谢产物,被宣传为一种药物,具有镇痛、抗炎和抗氧化作用。CBD 可能有望成为风湿性疾病的治疗方法,但迄今为止的证据仍然是临床前的。其在疼痛和炎症方面的临床前作用令人鼓舞,但缺乏临床研究,仅有一项关于膝骨关节炎的研究报告称 CBD 对症状有积极影响。CBD 产品可在柜台自由购买,并作为食品补充剂或保健产品进行销售。世界卫生组织已将纯 CBD 确定为安全且无滥用潜力,但这些产品不受药物监管标准的约束,导致制造实践和产品质量不一致。不仅 CBD 的分子浓度被确定为不准确,而且还存在包括重金属、农药、微生物和霉菌毒素以及添加的四氢大麻酚在内的污染物问题。由于细胞色素 P450 酶途径的代谢,药物相互作用可能构成潜在风险。希望使用 CBD 的患者应选择经过良好生产规范认证的产品,以夜间低剂量开始治疗,并在合理的时间范围内设定明确的治疗目标。治疗不应由非医疗人员进行管理。希望 CBD 可能成为一种有用的治疗方法,这必须通过合理的科学研究来证实。

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