Am J Psychiatry ：轻型颅脑外伤后继发成瘾障碍风险随时间变化

　　刊登于《美国精神病学杂志》2013年第四期的一项前瞻性队列研究发现，轻型颅脑外伤（TBI）后继发成瘾障碍的风险随时间延续呈先增高后降低的趋势。轻型TBI组与损伤程度相似的非轻型TBI对照组相较，发生特定成瘾障碍的风险较高，酒精依赖、尼古丁依赖及非依赖型的药物或酒精滥用风险显著增加，但风险随时间推移呈持续降低趋势。

　　军事人员暴露在较高的TBI风险中，这种风险可能是由战斗或其他原因引起的。关于中、重型TBI后遗症的描述已经非常详尽了，但是对于轻型TBI相关的远期功能减退却知之甚少。酒精和药物会增加TBI风险已成共识，但对于TBI是否会增加患者对酒精及药物的依赖了解极少。

　　超过50万名现役美国空军人员参与此研究，研究评估了现役美国飞行员中轻型TBI与成瘾障碍的可能联系。采用电子记录的方式记录相关的人口统计学数据、医疗及军用资料。专家组确定使用ICD-9-CM代码作为轻型TBI诊断鉴别标准。转归包括ICD-9-CM诊断的成瘾障碍。在对不同随访时长及潜在混杂因素进行控制的同时，使用Cox比例风险模型进行风险比率计算。

　　研究结果显示轻型TBI后继发成瘾障碍风险的时间变化规律与中、重型TBI有明显的区别。研究同时指出对轻型TBI后继发成瘾障碍进行筛查和预防是必要的，在军人及平民中进行轻型TBI后，近期和远期阶段性筛查或许是必要的。

与颅脑相关的拓展阅读：

• 上海市颅脑创伤研究所发表最新循证医学研究成果
• 重型创伤性颅脑损伤患者院外给予高渗盐复苏：一项随机对照试验 更多信息请点击：有关颅脑更多资讯

Risk for Addiction-Related Disorders Following Mild Traumatic Brain Injury in a Large Cohort of Active-Duty U.S. Airmen
Objective 
Military personnel are at increased risk for traumatic brain injury (TBI) from combat and noncombat exposures. The sequelae of moderate to severe TBI are well described, but little is known regarding long-term performance decrements associated with mild TBI. Furthermore, while alcohol and drug use are well known to increase risk for TBI, little is known regarding the reverse pattern. The authors sought to assess possible associations between mild TBI and addiction-related disorders in active-duty U.S. military personnel.
Method 
A historical prospective study was conducted using electronically recorded demographic, medical, and military data for more than a half million active-duty U.S. Air Force service members. Cases were identified by ICD-9-CM codes considered by an expert panel to be indicative of mild TBI. Outcomes included ICD-9-CM diagnoses of selected addiction-related disorders. Cox proportional hazards modeling was used to calculate hazard ratios while controlling for varying lengths of follow-up and potential confounding variables.
Results 
Airmen with mild TBI were at increased risk for certain addiction-related disorders compared with a similarly injured non-mild TBI comparison group. Hazards for alcohol dependence, nicotine dependence, and nondependent abuse of drugs or alcohol were significantly elevated, with a consistent decrease over time.
Conclusions 
A novel finding of this study was the initial increased risk for addiction-related disorders that decreased with time, thus eroding war fighter performance in a military population. Moreover, these results suggest that mild TBI is distinguished from moderate to severe TBI in terms of timing of the risk, indicating that there is a need for screening and prevention of addiction-related disorders in mild TBI. Screening may be warranted in military troops as well as civilians at both short- and long-term milestones following mild TBI.