普萘洛尔联合记忆唤起再巩固范式干预酒精依赖患者酒精渴求的研究  

Propranolol combined with memory retrieval reconsolidation procedure for the intervention of alcohol craving in patients with alcohol dependence

作　　者：徐鹏娇 于帅 王韩 王传升[1] 张瑞岭[1] 徐亚辉[2] Xu Pengjiao;Yu Shuai;Wang Han;Wang Chuansheng;Zhang Ruiling;Xu Yahui(Department of Addiction Medicine,the Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China;Department of Sleep Medicine,the Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China)

机构地区：[1]新乡医学院第二附属医院成瘾医学科,新乡453002 [2]新乡医学院第二附属医院睡眠医学科,新乡453002

出　　处：《中华精神科杂志》2023年第2期106-113,共8页Chinese Journal of Psychiatry

基　　金：国家自然科学基金(81601160);河南省精神心理疾病临床医学研究中心开放课题项目(2020-zxkfkt-007)。

摘　　要：目的探索普萘洛尔联合记忆唤起再巩固范式对酒精依赖患者酒精渴求的影响。方法纳入符合DSM-Ⅳ中关于酒精依赖诊断标准的54例酒精依赖患者,采用随机数字表法将患者分为研究组(n=28)和对照组(n=26)。研究组采用普萘洛尔联合记忆唤起再巩固范式,对照组采用安慰剂联合记忆唤起再巩固范式。在基线、关联学习、记忆检测阶段采用可视渴求量表(Visual Analog Scale,VAS)评估对酒瓶、倒酒、饮酒等图片(酒精相关线索图片,既往线索)及中性图片(新线索)诱发的酒精渴求程度,采用收缩压、舒张压、心率水平评估线索反应性。重复测量方差分析比较2组渴求程度,收缩压、舒张压以及心率水平的差异,并对线索反应性指标与渴求程度进行相关性分析。结果关联学习阶段:与学习前相比,条件性刺激(conditioned stimulus)关联学习(简称CS+,即中性图片与酒精配对学习)后2组收缩压、舒张压、心率水平均有不同程度的升高(F=52.79、42.44、49.53,均P<0.05);与基线相比,2组关联学习中性图片诱发的渴求程度的VAS评分升高(F=99.88、68.69,均P<0.01)。记忆检测阶段:(1)与对照组酒瓶、倒酒、饮酒图片及中性图片诱发的渴求程度的VAS评分相比,研究组的VAS评分降低(F=7.38、13.27、11.34、4.62,均P<0.05)。与关联学习阶段酒瓶、倒酒、饮酒图片及中性图片诱发的渴求程度的VAS评分相比,记忆检测阶段研究组的VAS评分显著降低(F=43.89、23.53、15.93、31.01,均P<0.05),而对照组的倒酒、饮酒图片诱发的渴求程度VAS评分显著升高(F=13.40、63.65,均P<0.05)。(2)记忆检测后,与对照组相比,研究组舒张压、心率水平降低(F=20.99、15.42,均P<0.05);与检测前相比,检测后研究组舒张压、心率水平降低(F=4.11、8.05,均P<0.05),对照组舒张压、心率水平升高(F=81.86、41.13,均P<0.05)。(3)研究组记忆检测前后舒张压差值与记忆检测与关联学习的中�Objective This study aims to explore the effect of propranolol combined with memory retrieval reconsolidation procedure on alcohol craving.Methods A total of 54 patients with alcohol dependence who met the diagnostic criteria for alcohol dependence in DSM-Ⅳwere enrolled.The patients were randomly located into the alcohol retrieval-propranolol group(study group,n=28)and the alcohol retrieval-placebo group(control group,n=26)using the random number table.The study group used propranolol combined with a memory retrieval reconsolidation procedure,while the control group used a placebo combined with a memory retrieval reconsolidation procedure.The Visual Analog Scale(VAS)was used to evaluate the degree of alcohol craving induced by images such as wine bottle,pouring wine,and drinking(alcohol-related cue images,previous cue images)and neutral images(new cue)at stages of baseline measures,relevance learning,and memory test.The systolic blood pressure,diastolic blood pressure,and heart rate were applied to evaluate cue responsiveness.Repeated measures analysis of variance was used to compare the craving degree,systolic blood pressure,diastolic blood pressure,and heart rate between the two groups.The correlation between cue responsiveness and craving degree was analyzed.Results Relevance learning stage:Compared with before learning,the levels of systolic blood pressure,diastolic blood pressure,and heart rate of the two groups increased in varying degrees after learning conditional stimulation-relevance learning+(CS+,namely neutral images paired learning with alcohol)(F=52.79,42.44,49.53,P<0.05).Compared with the baseline measures,the VAS of neutral images in relevancy learning increased(F=99.88,68.69,both P<0.01).Memory test stage:(1)Compared with the control group,the VAS scores of cravings induced by wine bottles,pouring wine,drinking images,and neutral images were lower in the study group(F=7.38,13.27,11.34,4.62,P<0.05).Compared with the VAS scores of cravings induced by wine bottles,pouring wine,drinking images,and

关 键 词：酒精相关性障碍 普萘洛尔 唤起再巩固 渴求 

分 类 号：R749.62[医药卫生—神经病学与精神病学]