美沙酮维持治疗对海洛因依赖者大脑度中心性影响的静息态fMRI研究  

The effect of methadone maintenance treatment on degree centrality in heroin dependent patients:a resting state fMRI study

作　　者：陈佳杰 王志东 金龙 李玮 李强 王玮 代晓峰 CHEN Jiajie;WANG Zhidong;JIN Long;LI Wei;LI Qiang;Wang Wei;DAI Xiaofeng(Department of Diagnostic Radiology,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,Chian;Department of Nuclear Medicine,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China;Department of Medical Imaging,96604 Military Hospital of China People's Liberation Army,Lanzhou 730030,China)

机构地区：[1]空军军医大学第二附属医院放射诊断科,西安710038 [2]空军军医大学第二附属医院核医学科,西安710038 [3]中国人民解放军96604部队医院医学影像科,兰州730030

出　　处：《磁共振成像》2024年第9期47-52,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：唐都青年自主创新科学基金项目(编号:2023BTDQN021);空军军医大学第二附属医院学科创新发展计划项目(编号:2021QYJC-003)。

摘　　要：目的探索美沙酮维持治疗(methadone maintenance treatment,MMT)对海洛因依赖(heroin dependence,HD)患者大脑拓扑特性度中心性(degree centrality,DC)的影响及其与心理行为学的相关性。材料与方法回顾性分析2016年1月至2017年12月于西安市灞桥区美沙酮门诊招募的41名正在接受MMT的HD患者,采集静息态功能磁共振成像(functional magnetic resonance imaging,fMRI)数据,评估稽延性戒断症状与渴求评分,纵向随访一年。对影像数据进行DC分析,并采用配对样本t检验进行纵向比较,差异脑区与心理学指标进行相关分析。结果HD患者入组时与MMT一年后稽延性戒断症状评分差异存在统计学意义(Z=3.004,P=0.003),渴求评分差异无统计学意义(Z=0.872,P=0.383)。与基线相比,HD患者经过MMT一年后,双侧丘脑、尾状核、壳核与左侧苍白球的DC降低;右侧舌回与距状回的DC值升高(Gaussian random field校正,单体素水平P<0.001,团块体素水平P<0.01,团块体素>95)。双侧尾状核及左侧苍白球DC值与戒断症状呈负相关性(r=-0.417,P=0.030;r=-0.392,P=0.043;r=-0.383,P=0.049),双侧壳核及左侧苍白球DC值的变化量与渴求的变化量呈正相关性(r=0.410,P=0.008;r=0.332,P=0.034;r=0.395,P=0.011)。结论美沙酮可能通过降低HD患者纹状体在成瘾奖赏脑网络中的中心性,从而调节HD患者戒毒后的稽延性戒断症状与心理渴求;同时可能抑制了冲动性,增强了视觉核心脑区的活动。该研究结果可以为美沙酮对HD患者治疗的神经机制提供影像学依据。Objective:To explore the effect of methadone maintenance treatment(MMT)on the degree centrality(DC)of topological characteristics of heroin dependence(HD)and its correlation with psychological behavior.Materials and Methods:A retrospective analysis was conducted on forty-one HD patients undergoing MMT program were recruited at Methadone Clinic in Baqiao District of Xi'an City from January 2016 to December 2017.The resting state functional magnetic resonance imaging(fMRI)data were collected.Protracted withdrawal symptoms and craving scores were assessed.The patients were followed longitudinally for one year.DC analysis was performed on the image data,and the paired sample t test was used for longitudinal comparison,and the correlation between different brain regions and psychological indicators was analyzed.Results:There was significant difference in the scores of protracted withdrawal symptoms of HD patients after MMT for one year(Z=3.004,P=0.003),but there was no significant difference in the scores of cravings(Z=0.872,P=0.383).Compared with baseline,one year after MMT,the DC of the bilateral thalamus,caudate nucleus,putamen,and left pallidum decreased in HD patients(Gaussian random field correction,voxel level P<0.001,cluster level P<0.01,clusters sizes>95).The DC value of the right lingual gyrus and calcarine gyrus increased after the same correction method.The DC value of bilateral caudate nucleus and left pallidum was negatively correlated with withdrawal symptoms(r=-0.417,P=0.030;r=-0.392,P=0.043;r=-0.383,P=0.049),and the change of DC value of bilateral putamen nucleus and left pallidum was positively correlated with the change of craving(r=0.410,P=0.008;r=0.332,P=0.034;r=0.395,P=0.011).Conclusions:Methadone may regulate the protracted withdrawal symptoms and psychological craving of HD patients by reducing the centrality of striatum in addiction reward brain network.It may inhibit impulsiveness and enhance the activity of the visual core brain area.These could provide imaging evidence for the neural mechan

关 键 词：海洛因依赖 美沙酮 度中心性 纹状体 奖赏 渴求 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R749.64[医药卫生—诊断学]