A comparative evaluation of thiol/disulfide homeostasis and ischemia-modified albumin levels in patients with heroin use disorder in remission and detoxification.

INTRODUCTION

Chronic heroin use disturbs body's redox (oxidant-antioxidant) balance, together with dynamic thiol-disulfide balance and ischemia-modified albumin; which are two distinct blood markers that may reflect the oxidative and ischemic load in substance dependence. It is still unclear whether these markers change across the clinical phases of heroin use disorder (HUD), or whether they relate to the affective and behavioral symptoms that dominate the clinical picture.

METHODS

In this cross-sectional study, 101 adults meeting DSM-5 criteria for HUD were split into a remission group (n = 52) and a detoxification group (n = 49). We measured serum native and total thiol, disulfide, the disulfide/native thiol, disulfide/total thiol and native thiol/total thiol ratios, and IMA. Participants also completed a symptom inventory, a craving measure, and scales for healthy-lifestyle behavior and nutrition attitude. Groups were compared with Student's t-test or the Mann-Whitney U test, categorical variables with chi-square or Fisher's exact test; associations were tested with Spearman correlations, and predictors of total thiol and IMA with multiple linear regression.

RESULTS

Patients in detoxification group scored markedly higher on depression, anxiety, anger, somatic symptoms, suicidal ideation, psychosis, sleep disturbance, dissociation and craving (all p ≤ 0.001), and lower on healthy-lifestyle and nutrition-attitude scores (p < 0.001). In contrast, no thiol/disulfide measure or IMA differed between phases. IMA correlated positively with depression (r = 0.254) and craving (r = 0.209); whereas the disulfide/thiol ratios correlated negatively, and native thiol/total thiol positively with healthy-lifestyle and nutrition-attitude scores. Regression models for total thiol and IMA were not statistically significant.

CONCLUSION

In HUD, redox and ischemia markers appear to follow symptom severity; especially depression, craving and health behavior, rather than the treatment phase itself. IMA, in particular, may reflect an oxidative and inflammatory component of mood regulation and craving.