本文選題：抑制性控制 + 美沙酮維持治療��； 參考：《第四軍醫(yī)大學(xué)》2014年碩士論文

【摘要】：目的： 海洛因依賴者存在明顯的抑制性控制功能損傷，美沙酮維持治療(methadonemaintenance treatment，MMT)是目前海洛因依賴治療的主要方法，其能減輕海洛因戒斷癥狀并有效降低渴求，然而有文獻報道美沙酮同樣會造成工作記憶、決策制定、注意力等認(rèn)知功能損傷，美沙酮會對患者抑制性控制功能產(chǎn)生怎樣的影響，目前尚存在爭論。其次，MMT后較高的復(fù)吸率一直是治療的難點，患者抑制性控制功能的優(yōu)劣是否與復(fù)吸有關(guān)有待進一步研究。因此本研究擬采用功能磁共振成像技術(shù)（functional Magnetic Resonance Imaging，fMRI），利用事件相關(guān)的go-nogo任務(wù)（go-nogo task，GNG）范式，探討美沙酮對抑制性控制功能的影響及抑制性控制功能與復(fù)吸的關(guān)系。 方法：實驗一對37例MMT患者根據(jù)MMT時間分為短期治療(short-term MMT，SMMT)組(2年，19例)以及長期治療(1ong-term MMT，LMMT)組(≥2年，18例)。在磁共振掃描的同時完成事件相關(guān)的go-nogo任務(wù)，所得的數(shù)據(jù)利用統(tǒng)計參數(shù)圖(StatisticalParametric Mapping，SPM)8軟件進行數(shù)據(jù)處理，獲得所有被試在成功nogo＞go條件下的大腦激活圖以及組間的大腦激活圖。對產(chǎn)生腦區(qū)活動顯著差異區(qū)域，以t值最高的體素為圓心，半徑為2mm，勾畫球形感興趣區(qū)（Region of Interest，ROI），分別提取被試各ROI激活的信號強度，與美沙酮使用情況進行偏相關(guān)分析。實驗二對實驗一的被試連續(xù)隨訪6個月，根據(jù)被試是否復(fù)吸將被試分為戒斷組（12例）和復(fù)吸組（relapse，RE,17例）。利用統(tǒng)計參數(shù)圖(Statistical Parametric Mapping，SPM)8軟件進行數(shù)據(jù)處理，獲得所有被試在成功nogo＞go條件下的大腦激活圖以及組間的大腦激活圖。對產(chǎn)生腦區(qū)活動顯著差異區(qū)域，以t值最高的體素為圓心，半徑為2mm，，勾畫球形感興趣區(qū)（Region of Interest，ROI）激活的信號強度，分別提取被試各ROI激活的信號強度，與美沙酮及海洛因使用情況進行偏相關(guān)分析。 結(jié)果： 實驗一反應(yīng)抑制條件下，相對于長期MMT患者，短期MMT患者背側(cè)前扣帶（Dorsal anterior cingulate cortex，dACC）激活程度明顯增強，并且dACC激活程度與患者美沙酮維持總量呈明顯負(fù)相關(guān)關(guān)系。 實驗二反應(yīng)抑制條件下，相對于復(fù)吸的海洛因依賴者，戒斷者左側(cè)輔助運動前區(qū)（Pre-supplementary motor area，pre-SMA）、丘腦及右側(cè)中扣帶回（Middle cingulatecortex，MCC）、小腦激活程度顯著增強。未發(fā)現(xiàn)這些激活的腦區(qū)與海洛因及美沙酮各變量存在相關(guān)關(guān)系。 結(jié)論： 實驗一本研究通過對比長期及短期MMT患者，我們發(fā)現(xiàn)長期MMT可能會損傷海洛因依賴者的抑制性控制功能，這可能是導(dǎo)致MMT患者較高復(fù)吸率的相關(guān)因素之一。 實驗二本研究通過對比海洛因戒斷者及復(fù)吸者，我們發(fā)現(xiàn)戒斷者抑制性控制相關(guān)功能更為優(yōu)越，抑制性控制功能可能作為預(yù)測海洛因依賴者復(fù)吸相關(guān)神經(jīng)生物學(xué)指標(biāo)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.
Result錛

本文編號：1909787