PDF(Pubmed)
Abstract：
UNASSIGNED: In addition to the more well-known adverse effects of opioids, such as constipation, mounting evidence supports underlying immunosuppressive effects as well.
UNASSIGNED: In this study, we provide a narrative review of preclinical and clinical evidence of opioid suppression of the immune system as well as possible considerations for therapies.
UNASSIGNED: In vitro and animal studies have shown clear effects of opioids on inflammatory cytokine expression, immune cell activity, and pathogen susceptibility. Observational data in humans have so far supported preclinical findings, with multiple reports of increased rates of infections in various settings of opioid use. However, the extent to which this risk is due to the impact of opioids on the immune system compared with other risk factors associated with opioid use remains uncertain. Considering the data showing immunosuppression and increased risk of infection with opioid use, measures are needed to mitigate this risk in patients who require ongoing treatment with opioids. In preclinical studies, administration of opioid receptor antagonists blocked the immunomodulatory effects of opioids.
UNASSIGNED: As selective antagonists of peripheral opioid receptors, peripherally acting mu-opioid receptor (MOR) antagonists may be able to protect against immune impairment while still allowing for opioid analgesia. Future research is warranted to further investigate the relationship between opioids and infection risk as well as the potential application of peripherally acting MOR antagonists to counteract these risks.
UNASSIGNED: In this study, we provide a narrative review of preclinical and clinical evidence of opioid suppression of the immune system as well as possible considerations for therapies.
UNASSIGNED: In vitro and animal studies have shown clear effects of opioids on inflammatory cytokine expression, immune cell activity, and pathogen susceptibility. Observational data in humans have so far supported preclinical findings, with multiple reports of increased rates of infections in various settings of opioid use. However, the extent to which this risk is due to the impact of opioids on the immune system compared with other risk factors associated with opioid use remains uncertain. Considering the data showing immunosuppression and increased risk of infection with opioid use, measures are needed to mitigate this risk in patients who require ongoing treatment with opioids. In preclinical studies, administration of opioid receptor antagonists blocked the immunomodulatory effects of opioids.
UNASSIGNED: As selective antagonists of peripheral opioid receptors, peripherally acting mu-opioid receptor (MOR) antagonists may be able to protect against immune impairment while still allowing for opioid analgesia. Future research is warranted to further investigate the relationship between opioids and infection risk as well as the potential application of peripherally acting MOR antagonists to counteract these risks.
摘要：
■除了众所周知的阿片类药物的不良反应外，比如便秘，越来越多的证据也支持潜在的免疫抑制作用。
■在这项研究中，我们对阿片类药物抑制免疫系统的临床前和临床证据以及治疗的可能考虑因素进行了叙述性综述.
■体外和动物研究表明，阿片类药物对炎性细胞因子表达有明确的影响，免疫细胞活性，和病原体易感性。迄今为止，人类的观察数据支持临床前发现，在各种阿片类药物使用情况下，有多个感染率上升的报告。然而,与阿片类药物使用相关的其他风险因素相比,阿片类药物对免疫系统的影响导致这种风险的程度仍不确定.考虑到显示免疫抑制和阿片类药物感染风险增加的数据，需要持续接受阿片类药物治疗的患者需要采取措施来降低这种风险.在临床前研究中,阿片受体拮抗剂的给药阻断了阿片类药物的免疫调节作用。
■作为外周阿片受体的选择性拮抗剂，外周作用的μ阿片受体（MOR）拮抗剂可能能够防止免疫损伤，同时仍允许阿片类药物镇痛。未来的研究有必要进一步研究阿片类药物与感染风险之间的关系，以及外周作用MOR拮抗剂在抵消这些风险方面的潜在应用。
■在这项研究中，我们对阿片类药物抑制免疫系统的临床前和临床证据以及治疗的可能考虑因素进行了叙述性综述.
■体外和动物研究表明，阿片类药物对炎性细胞因子表达有明确的影响，免疫细胞活性，和病原体易感性。迄今为止，人类的观察数据支持临床前发现，在各种阿片类药物使用情况下，有多个感染率上升的报告。然而,与阿片类药物使用相关的其他风险因素相比,阿片类药物对免疫系统的影响导致这种风险的程度仍不确定.考虑到显示免疫抑制和阿片类药物感染风险增加的数据，需要持续接受阿片类药物治疗的患者需要采取措施来降低这种风险.在临床前研究中,阿片受体拮抗剂的给药阻断了阿片类药物的免疫调节作用。
■作为外周阿片受体的选择性拮抗剂，外周作用的μ阿片受体（MOR）拮抗剂可能能够防止免疫损伤，同时仍允许阿片类药物镇痛。未来的研究有必要进一步研究阿片类药物与感染风险之间的关系，以及外周作用MOR拮抗剂在抵消这些风险方面的潜在应用。
