本文選題：腦溫度　切入點：藥物依賴　出處：《廣州中醫(yī)藥大學》2017年博士論文

【摘要】：目的:探討氫質子磁共振波譜(1H MRS)顯示海洛因依賴者前額葉及海馬區(qū)損傷后的代謝異常,利用化學位移值溫度相關性的原理,應用相關方程轉換,測量海洛因依賴者前額葉皮層與海馬絕對溫度變化,間接反映其存在的微觀病理生理變化,探討其在評估藥物成癮及渴求機制的可行性及意義。方法:選取24例處于戒斷治療期(戒斷治療時間2-6月)的男性海洛因依賴者作為實驗組,選取24例年齡及受教育時間與實驗組匹配的男性健康志愿者作為對照組。所有被試進行常規(guī)軸位T2WI、FLAIR掃描及前額葉皮層(感興趣區(qū)選擇跨中線包括左右側皮層)、雙側海馬的單體素磁共振波譜掃描。實驗組的磁共振波譜掃描分別在靜息狀態(tài)和視覺刺激(呈現(xiàn)海洛因相關圖片)誘導渴求狀態(tài)下連續(xù)進行,兩次掃描確保其掃描參數(shù)、感興趣區(qū)的位置及體積完全一致。分析波譜圖像,測量記錄前額葉皮質和雙側海馬N-乙酰天門冬氨酸(NAA)/肌酸(Cr)比值及NAA化學位移值;以NAA為參考,根據(jù)腦溫度(T)與NAA化學位移(CSNAA)之間的關系:T=37+100(CSNAA-2.035),計算前額葉皮層及海馬絕對腦溫度;將NAA/Cr值、腦溫度值作相關統(tǒng)計學分析比較。結果:1.海洛因依賴組及對照組常規(guī)MRI腦內均無明顯異常信號灶,未見明確結構異常。前額葉皮層及雙側海馬1HMRS基線穩(wěn)定,各主要代謝物波峰清晰可辨。2.比較海洛因依賴組靜息態(tài)與對照組:海洛因依賴組前額葉皮層及左側海馬NAA/Cr值較正常對照組下降,差異具有統(tǒng)計學意義(P0.05);海洛因依賴組右側海馬NAA/Cr值與對照組比較無顯著統(tǒng)計學差異(P0.05)。3.比較海洛因依賴組靜息態(tài)與視覺刺激態(tài):前額葉皮層及兩側海馬溫度兩種狀態(tài)的比較均無顯著統(tǒng)計學差異(P0.05)。4.比較海洛因依賴組靜息態(tài)與對照組:海洛因依賴組前額葉皮層溫度上升,差異有統(tǒng)計學意義(P0.05)。海洛因依賴組雙側海馬溫度與對照組比較無顯著統(tǒng)計學差異(P0.05)。5.將海洛因依賴組三組腦區(qū)靜息態(tài)NAA/Cr、溫度值以及海洛因依賴組靜息態(tài)-刺激態(tài)溫度差(△T)與海洛因吸食總量作直線相關與回歸分析發(fā)現(xiàn):海洛因組靜息態(tài)前額葉皮層溫度與海洛因吸食總量存在正的直線相關關系(P0.05),其決定系數(shù)(R Square,R2)為 0.225。結論:常規(guī)MRI對顯示海洛因腦損傷微觀病理改變有較大的限制,1H MRS可以較好顯示及評價早期海洛因毒性效應引起的相應腦區(qū)神經(jīng)元及代謝受損改變。NAA含量變化反映神經(jīng)元的數(shù)量、密度和功能狀態(tài),而利用NAA化學位移值可無創(chuàng)性測量藥物依賴者相應成癮腦區(qū)腦溫度改變。額葉是海洛因成癮關鍵及易損腦區(qū),靜息態(tài)前額葉皮層溫度的升高可能是神經(jīng)元損傷、腦血流量及腦代謝改變的綜合體現(xiàn)。盡管腦溫度內在機制及影響因素復雜,但對探討藥物依賴機制、評價成癮與渴求無疑是一個有潛力的評價指標,應用前景較好。
[Abstract]:Objective: To investigate the proton magnetic resonance spectroscopy (1H MRS) that prefrontal and hippocampus injury after the abnormal metabolism of heroin dependence, using the principle of chemical shift temperature dependence, using equation conversion, prefrontal cortex and hippocampus were absolute temperature measuring changes in heroin dependence, indirectly reflect the microscopic pathological physiological changes of its existence, study the feasibility and significance of assessment of drug addiction and craving mechanism. Methods: 24 cases in the treatment of withdrawal period (withdrawal treatment time is 2-6 months) male heroin addicts were selected as experimental group, 24 cases of age and education, and the experimental group of male healthy volunteers as control group. All of the subjects were conventional shaft T2WI, FLAIR scan and prefrontal cortex (including midline lateral cortex region of interest), single bilateral hippocampal magnetic resonance spectroscopy scanning. The experimental group co The vibration spectrum scanning respectively in the resting state and visual stimulation (presentation of heroin related pictures) induced craving state continuously, the two scan to ensure the scanning parameters, the position and volume of the area of interest is exactly the same. The analysis of the spectral image, measuring and recording the prefrontal cortex and hippocampus of N- double N-acetylaspartate (NAA) / creatine (Cr) ratio and NAA chemical shifts; reference to NAA, according to the brain temperature (T) and NAA chemical shift (CSNAA): the relationship between T=37+100 (CSNAA-2.035), prefrontal cortex and hippocampus to calculate absolute brain temperature; the NAA value of /Cr, the relevant statistical analysis and comparison. The value of brain temperature results: 1. heroin dependence group and control group of conventional MRI in the brain were not significantly abnormal signal lesions, no clear structural abnormalities. The prefrontal cortex and bilateral hippocampus 1HMRS baseline stability, the main metabolites peak of.2. is clearly the heroin dependence group and resting state The control group: compared with normal control group decreased prefrontal cortex and left hippocampus NAA/Cr group of heroin dependence, the difference was statistically significant (P0.05); value compared with the control group there was no significant difference between group NAA/Cr of the right hippocampus of heroin dependence group (P0.05) in resting state and visual.3. of heroin dependence: thorn excited state prefrontal cortex and bilateral hippocampus temperature two for the comparison there were no significant differences in resting state (P0.05) group compared with control group.4.: heroin dependence group increased the prefrontal cortex temperature of heroin dependence, the difference was statistically significant (P0.05). The heroin dependence group bilateral hippocampal temperature compared with the control group, there was no statistically significant difference (P0.05.5.) the heroin dependence group three group of brain in the resting state NAA/Cr, temperature value and the heroin dependence group in resting state - thorn excited state temperature difference (delta T) and the total amount of heroin for a straight line correlation and regression analysis. The resting state of prefrontal cortex: heroin group and heroin temperature had a linear relationship is the total (P0.05), the coefficient of determination (R Square, R2 0.225.) conclusion: the conventional MRI to show a change has greatly restricted heroin microscopic pathological brain injury, 1H and MRS can better display the corresponding evaluation of neurons in brain areas and metabolism the effect of early damage caused by heroin toxicity changing.NAA content to reflect changes in the number of neurons, density and functional status, and the use of NAA chemical shift value of noninvasive measurement of brain temperature corresponding drug addicts addiction brain areas change. The frontal lobe is the key of heroin addiction and vulnerable brain regions, resting prefrontal cortex temperature may be neuron injury change, comprehensive reflection of cerebral blood flow and cerebral metabolism. Although the inner mechanism and its influential factors of brain temperature is complex, but to investigate the drug dependent mechanism, evaluation of addiction and thirst There is no doubt that it is a potential evaluation index, and it has a good prospect of application.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R445.2;R749.61

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