阿片类拮抗剂对暴食行为患者的疗效：一项系统回顾和荟萃分析。

IF 7.5 1区医学 Q1 BEHAVIORAL SCIENCES

Neuroscience and Biobehavioral Reviews Pub Date : 2025-03-15 DOI:10.1016/j.neubiorev.2025.106108

Yi-Ya Fang , Yi-Chun Yeh , Tai-Ling Liu , Hsu Tien-Wei , Chih-Hung Ko

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引用次数: 0

摘要

背景：暴饮暴食（BE）是指在短时间内摄入大量食物并感到失去控制。BE的神经生物学机制涉及奖励和抑制控制系统的失调，内源性阿片系统起着关键作用。阿片类拮抗剂和安非他酮联合治疗可能通过影响奖励系统来降低BE，但关于其有效性的证据仍不确定。本荟萃分析回顾了探索阿片类拮抗剂对BE频率、BE严重程度、体重和情绪影响的随机对照试验（rct）。方法：我们系统地检索PubMed、Embase、Cochrane CENTRAL、Web of Science和ClinicalTrials.gov，以确定2023年5月14日之前发表的rct。主要结局是BE的严重程度和频率。次要结局是体重变化百分比和抑郁症状。结果：8项随机对照试验纳入我们的分析。阿片类拮抗剂显著降低BE频率（平均标准差[SMD] = -0.624, 95%可信区间[CI] = -1.181至-0.067,p = 0.028）和体重百分比变化（SMD = -0.981, 95% CI = -1.657至-0.305,p = 0.004），具有中等到较大的效应量。相反，阿片类拮抗剂没有显著改善BE严重程度（Hedges' g = -0.210, 95% CI = -0.431至0.011,p = 0.063）或抑郁症状（Hedges' g = -0.190, 95% CI = -0.434至0.053,p = 0.125）。meta回归分析显示，纳曲酮的剂量在降低BE频率和体重百分比方面起调节作用。结论：本荟萃分析表明，阿片类拮抗剂可有效减轻BE频率，降低体重损失百分比。

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Efficacy of opioid antagonist in patients with binge eating behavior: A systemic review and meta-analysis

Background

Binge eating (BE) involves consuming unusually large amounts of food within a short period and feeling a loss of control. Neurobiological mechanisms underlying BE involve dysregulation of reward and inhibitory control systems, with the endogenous opioid system playing a key role. Opioid antagonists and the combination therapies with bupropion may have potential to reduce BE by affecting the reward system, but evidence regarding their effectiveness remains inconclusive. This meta-analysis reviewed randomized controlled trials (RCTs) exploring the effects of opioid antagonists on BE frequency, BE severity, body weight, and mood.

Methods

We systematically searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov to identify RCTs published before May 14, 2023,. The primary outcomes were BE severity and frequency. The secondary outcomes were percentage change in body weight and depressive symptoms.

Results

Eight RCTs were included in our analysis. Opioid antagonists significantly reduced BE frequency (standard difference in means [SMD] = −0.624, 95 % confidence interval [CI] = −1.181 to −0.067, p = 0.028) and changes in body weight percentage (SMD = −0.981, 95 % CI = −1.657 to −0.305, p = 0.004), with a moderate-to-large effect size. Conversely, opioid antagonists didn’t significantly improve BE severity (Hedges’ g = −0.210, 95 % CI = −0.431 to 0.011, p = 0.063) or depressive symptoms (Hedges’ g = −0.190, 95 % CI = −0.434 to 0.053, p = 0.125). Meta-regression analysis revealed that the dosage of naltrexone served as a moderator in reducing BE frequency and body weight percentage.

Conclusion

The present meta-analysis indicated that opioid antagonists effectively alleviate BE frequency and reduce percentage loss in body weight.

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来源期刊

Neuroscience and Biobehavioral Reviews 医学-行为科学

CiteScore

14.20

自引率

3.70%

发文量

466

审稿时长

6 months

期刊介绍： The official journal of the International Behavioral Neuroscience Society publishes original and significant review articles that explore the intersection between neuroscience and the study of psychological processes and behavior. The journal also welcomes articles that primarily focus on psychological processes and behavior, as long as they have relevance to one or more areas of neuroscience.