美沙酮维持治疗的海洛因依赖者大脑抑制性控制功能的fMRI研究

发布时间：2018-05-19 10:41

  本文选题：抑制性控制 + 美沙酮维持治疗　； 参考：《第四军医大学》2014年硕士论文

【摘要】：目的： 海洛因依赖者存在明显的抑制性控制功能损伤，美沙酮维持治疗(methadonemaintenance treatment，MMT)是目前海洛因依赖治疗的主要方法，其能减轻海洛因戒断症状并有效降低渴求，然而有文献报道美沙酮同样会造成工作记忆、决策制定、注意力等认知功能损伤，美沙酮会对患者抑制性控制功能产生怎样的影响，目前尚存在争论。其次，MMT后较高的复吸率一直是治疗的难点，患者抑制性控制功能的优劣是否与复吸有关有待进一步研究。因此本研究拟采用功能磁共振成像技术（functional Magnetic Resonance Imaging，fMRI），利用事件相关的go-nogo任务（go-nogo task，GNG）范式，探讨美沙酮对抑制性控制功能的影响及抑制性控制功能与复吸的关系。 方法：实验一对37例MMT患者根据MMT时间分为短期治疗(short-term MMT，SMMT)组(2年，19例)以及长期治疗(1ong-term MMT，LMMT)组(≥2年，18例)。在磁共振扫描的同时完成事件相关的go-nogo任务，所得的数据利用统计参数图(StatisticalParametric Mapping，SPM)8软件进行数据处理，获得所有被试在成功nogo＞go条件下的大脑激活图以及组间的大脑激活图。对产生脑区活动显著差异区域，以t值最高的体素为圆心，半径为2mm，勾画球形感兴趣区（Region of Interest，ROI），分别提取被试各ROI激活的信号强度，与美沙酮使用情况进行偏相关分析。实验二对实验一的被试连续随访6个月，根据被试是否复吸将被试分为戒断组（12例）和复吸组（relapse，RE,17例）。利用统计参数图(Statistical Parametric Mapping，SPM)8软件进行数据处理，获得所有被试在成功nogo＞go条件下的大脑激活图以及组间的大脑激活图。对产生脑区活动显著差异区域，以t值最高的体素为圆心，半径为2mm，，勾画球形感兴趣区（Region of Interest，ROI）激活的信号强度，分别提取被试各ROI激活的信号强度，与美沙酮及海洛因使用情况进行偏相关分析。 结果： 实验一反应抑制条件下，相对于长期MMT患者，短期MMT患者背侧前扣带（Dorsal anterior cingulate cortex，dACC）激活程度明显增强，并且dACC激活程度与患者美沙酮维持总量呈明显负相关关系。 实验二反应抑制条件下，相对于复吸的海洛因依赖者，戒断者左侧辅助运动前区（Pre-supplementary motor area，pre-SMA）、丘脑及右侧中扣带回（Middle cingulatecortex，MCC）、小脑激活程度显著增强。未发现这些激活的脑区与海洛因及美沙酮各变量存在相关关系。 结论： 实验一本研究通过对比长期及短期MMT患者，我们发现长期MMT可能会损伤海洛因依赖者的抑制性控制功能，这可能是导致MMT患者较高复吸率的相关因素之一。 实验二本研究通过对比海洛因戒断者及复吸者，我们发现戒断者抑制性控制相关功能更为优越，抑制性控制功能可能作为预测海洛因依赖者复吸相关神经生物学指标之一。
[Abstract]:Objective:
Heroin addicts have obvious inhibitory control impairment. Methadonemaintenance treatment (MMT) is the main method of heroin dependence therapy at present. It can reduce heroin withdrawal symptoms and reduce craving. However, it is reported that methadone also causes working memory, decision making and attention. When cognitive impairment, what effect of methadone on the inhibitory control function of patients, there is still controversy. Second, the high relapse rate after MMT is always the difficulty of treatment. Tional Magnetic Resonance Imaging, fMRI), using the event related Go-NoGo task (Go-NoGo task, GNG) paradigm, the effects of methadone on inhibitory control and the relationship between inhibitory control function and relapse are discussed.
Methods: a pair of 37 patients with MMT were divided into short term treatment (short-term MMT, SMMT) group (2 years, 19 cases) and long-term treatment (1ong-term MMT, LMMT) group (2 years, 18 cases). The event related Go-NoGo tasks were completed at the same time of magnetic resonance scanning. The data obtained by the statistical parameter diagram (StatisticalParametric Mapping, SPM) 8 soft. For data processing, the brain activation maps and brain activation diagrams of all subjects under the successful Nogo > go were obtained. The significant differences in the region of brain activity, with the voxel with the highest t value as the center, the radius of 2mm, and the spherical region of interest (Region of Interest, ROI) were drawn, and the signal intensity activated by ROI was extracted, respectively. The use of methadone was analyzed. In experiment two, the subjects were followed up for 6 months. According to whether the subjects were relapsed, the subjects were divided into abstinence group (12 cases) and relapse group (relapse, RE, 17 cases). Statistical parameters (Statistical Parametric Mapping, SPM) 8 software were used for data processing, and all the subjects were successful in Nogo > go. The brain activation diagram under the condition and the brain activation map between groups. The region with significant difference in brain activity, with the highest t value of the voxel as the center and the radius of 2mm, draws the signal intensity activated by the Region of Interest, ROI, and extracts the signal intensity of the ROI excitation of the subjects respectively, and the use of methadone and heroin. Partial correlation analysis.
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