摘要
目的:探索A型与B型酒依赖患者临床特征及治疗结局方面的差异,明确酒依赖患者复饮的危险因素。方法:选取2018年1月至2020年12月在北京回龙观医院成瘾医学中心住院的男性酒依赖患者为研究对象,分为A型酒依赖组(n=77)和B型酒依赖组(n=87)。所有患者给予常规急性脱瘾治疗,并在治疗后随访其复饮情况。比较两组患者临床特征及3个月内不同时间点治疗结局的差异。根据3个月后是否复饮将患者分为复饮组和非复饮组,使用SPSS 25.0软件通过Logistic回归模型筛选酒依赖患者复饮的危险因素。结果:两型患者在受教育年限、婚姻状况、吸烟状况及工作在职情况方面均差异无统计学意义(均P>0.05),但在共同居住者的比例(χ^(2)=5.69,P=0.017)、酗酒家族史(χ^(2)=13.32,P<0.001)方面差异有统计学意义。两型患者在起病年龄(t=-7.28,P<0.001)、首次饮酒年龄(t=-2.36,P=0.020)、存在晨起饮酒(χ^(2)=7.83,P=0.005)、精神病性症状(χ^(2)=4.31,P=0.038)、戒断后抽搐发作的比例(χ^(2)=5.30,P=0.021)、酒精使用障碍筛查量表评分(t=4.30,P<0.001)差异有统计学意义。随访的第4周末、8周末,两型酒依赖患者的复饮后饮酒频率[0(0,3),0(0,0),Z=-4.13,P<0.001;3(0,3),0(0,3),Z=-4.42,P<0.001]及复饮率[40(45.98%),9(11.69%),χ^(2)=22.92,P<0.001;61(70.11%),24(31.17%),χ^(2)=24.82,P<0.001]均差异有统计学意义。随访12周末,两型酒依赖患者首次复饮间隔天数[20(7,30)d,88(38,90)d,Z=-7.83,P<0.001]、累计戒酒持续时间[4(0,8)周,12(4,12)周,Z=-5.13,P<0.001]、累计复饮率[71(81.60%),25(32.47%),χ^(2)=40.62,P<0.001]、复饮后饮酒频率[3(3,3),0(0,3),Z=-5.54,P<0.001]及日均饮酒量减少量(t=3.36,P<0.001)均差异有统计学意义。Logistic回归模型显示B型酒依赖(OR=3.121,P=0.03,95%CI=1.12~8.72)和酒精使用障碍筛查量表评分(OR=1.498,P<0.01,95%CI=1.29~1.74)是酒依赖患者复饮的危险因素。结论:两型酒依赖患者的临床特征及治疗结局存在明显差异,B型酒依赖是酒依赖患者复饮的危险因素,验证了酒依赖分型的合理性和必要性。
Objective To explore the differences in clinical characteristics and treatment outcomes between patients with type A and type B alcohol dependence,and to find the independent risk factors of relapse.Methods Alcohol-dependent male patients attending the Addiction Medicine Center of Beijing Huilongguan Hospital from January 2018 to December 2020 were selected for the study and divided into type A alcohol-dependent group(n=77)and type B alcohol-dependent group(n=87).All patients were given acute detoxification treatment and were followed up after treatment on relapse to drinking.Differences in demographic and clinical data were compared between the two groups,and differences in treatment outcomes between the two groups at different time points over 3 months were compared.Patients were divided into relapse group and non-relapse group according to whether they drank again after 3 months.Logistic regression model was established to screen the risk factors of relapse of alcohol-dependent patients by SPSS 25.0 software.Results There was no significant difference between the two types of patients in years of education,marital status,smoking status and working status(all P>0.05),but the proportion of co-residents(χ^(2)=5.69,P=0.017)and the proportion of positive family history of alcoholism were significant difference between the two type of patients(χ^(2)=13.32,P<0.001).There were statistically significant differences between the two types of patients in the onset time(t=-7.28,P<0.001),the first drinking age(t=-2.36,P=0.020),the proportion of drinking in the morning(χ^(2)=7.83,P=0.005),psychotic symptoms(χ^(2)=4.31,P=0.038),convulsions after withdrawal(χ^(2)=5.30,P=0.021),and alcohol use disorder identification test(AUDIT)score(t=4.30,P<0.001).At the 4th and 8th weekend of the follow-up,there were statistically significant differences in drinking frequency(0(0,3),0(0,0),Z=-4.13,P<0.001;3(0,3),0(0,3),Z=-4.42,P<0.001)and relapse rate(40(45.98%),9(11.69%),χ^(2)=22.92,P<0.001;61(70.11%),24(31.17%),χ^(2)=24.82,P<0.001)between the two types of alcohol dependence patients after drinking again.After 12-week follow-up,there were statistically significant differences between the two types of alcohol-dependent patients in the interval of first drinking(20(7,30)d,88(38,90)d,Z=-7.83,P<0.001),the cumulative duration of abstinence(4(0,8)weeks,12(4,12)weeks,Z=-5.13,P<0.001),the cumulative rate of abstinence(71(81.60%),25(32.47%),χ^(2)=40.62,P<0.001),the frequency of drinking after abstinence(3(3,3),0(0,3),Z=-5.54,P<0.001),and the reduction of daily average alcohol consumption(t=3.36,P<0.001).Logistic regression model showed that type B alcohol dependence(OR=3.121,P=0.03,95%CI:1.12-8.72)and AUDIT score(OR=1.498,P<0.01,95%CI:1.29-1.74)were the risk factors for relapse of alcohol-dependent patients.Conclusions Patients with type A and type B alcohol dependence have obvious differences in clinical characteristics and treatment outcomes,and type B alcohol dependence is independent risk factor for relapse to drinking in alcohol-dependent patients,which validate the rationality and necessity of alcohol dependence subtypes.
作者
蔡海鹏
杜若南
王志仁
李伟
赵荣江
杨清艳
王鑫
杨可冰
Cai Haipeng;Du Ruonan;Wang Zhiren;Li Wei;Zhao Rongjiang;Yang Qingyan;Wang Xin;Yang Kebing(Gerontology Department,Beijing Huilongguan Hospital,Beijing 100096,China;Peking University Huilongguan Clinical Medical School,Beijing 100096,China;Science and Technology Department,Beijing Huilongguan Hospital,Beijing 100096,China;The 5th Department,Beijing Huilongguan Hospital,Beijing 100096,China;The 2nd Department,Beijing Huilongguan Hospital,Beijing 100096,China)
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2023年第3期238-244,共7页
Chinese Journal of Behavioral Medicine and Brain Science
基金
北京市医院管理局临床医学发展专项(XMLX201834)
首都卫生发展科研专项项目(首发2020-2-2134)
北京市属医院科研培育计划项目(PX2021072)。
关键词
酒精依赖
A型酒精依赖
B型酒精依赖
复饮
男性
Alcohol dependence
Type A alcohol dependence
Type B alcohol dependence
Relapse
Male
作者简介
通信作者:杨可冰,Email:13910032541@163.com。
