A Randomized, Controlled Study of Treatment for Alcohol Dependence in Patients Awaiting Liver Transplantation
A Randomized, Controlled Study of Treatment for Alcohol Dependence in Patients Awaiting Liver Transplantation
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DOI：
10.1002/lt.22259
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发表时间：
2011-05-01
影响因子：
4.6
通讯作者：
Lucey, Michael R.
中科院分区：
文献类型：
--
作者：
Weinrieb, Robert M.;Van Horn, Deborah H. A.;Lucey, Michael R.
在美国，酒精是肝硬化的第二大常见原因，需要进行肝移植，但移植后饮酒率接近50%，并且在这一人群中没有酒精中毒治疗的对照临床试验。符合条件的患者被随机分配接受动机增强疗法（MET），或转诊至当地治疗来源（“照常治疗”[TAU]）。成瘾行为，情绪状态和一般健康状况进行了比较。除了在医疗紧急情况下，通过保密饮酒问卷来鼓励关于饮酒的坦率。研究了91例受试者; 46例接受MET，45例接受TAU，29例进行移植（MET，n = 13; TAU，n = 16）。共有69例受试者完成了24周的观察，25例受试者在96周时接受了评估。未观察到研究出席率存在差异，但MET受试者出席1次或多次治疗的人数显著更多。23例受试者（25%的样本）在随机化后但移植前饮酒。排除一个极端的离群值，MET饮酒者每饮酒日的饮酒量明显少于TAU饮酒者。两种治疗方案均未导致心理健康指标出现显著差异。总之，尽管MET对情绪或一般健康结果没有显著的TAU益处，但本研究为MET限制酒精依赖肝移植候选人移植前饮酒的数量和频率提供了一定程度的支持。然而，由于研究受试者数量有限，必须谨慎解释这些数据。进一步的研究，以验证我们的研究结果或确定更好的方法，以确定和干预患者在移植前和移植后饮酒的风险应该继续下去。肝移植17：539-547，2011。(C)2011年AASLD。
Alcohol is the second most common cause of cirrhosis necessitating liver transplantation in the United States, yet rates of posttransplant drinking approach 50% and no controlled clinical trials of alcoholism treatment exist in this population. Eligible patients were randomly assigned to receive Motivational Enhancement Therapy (MET), or referral to local treatment sources("treatment as usual'' [TAU]). Addictive behavior, mood states, and general health were compared. Candor concerning alcohol use was encouraged by keeping drinking questionnaires in confidence, except in medical emergencies. Ninety-one subjects were studied; 46 received MET, 45 received TAU, 29 proceeded to transplantation (MET, n = 13; TAU, n = 16). A total of 69 subjects completed 24 weeks of observation, and 25 subjects were assessed at 96 weeks. No difference in study attendance was observed, but significantly more MET subjects attended 1 or more treatment sessions. Twenty-three subjects (25% of sample) drank after randomization but before transplant. Excluding an extreme outlier, MET drinkers had significantly fewer drinks per drinking days than TAU drinkers. Neither treatment plan resulted in significant variances in measures of psychosocial health. In conclusion, although MET afforded no significant benefit over TAU for mood or general health outcomes, this study provides some degree of support for MET to limit the quantity and frequency of pretransplant alcohol consumption among liver transplant candidates with alcohol dependence. However, because of the limited number of study subjects, these data must be interpreted cautiously. Further research to validate our findings or to identify better methods to identify and intervene with patients at risk of pretransplant and posttransplant drinking should continue. Liver Transpl 17:539-547, 2011. (C) 2011 AASLD.