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.
The effect of methadone maintenance treatment on degree centrality in heroin dependent patients:a resting state fMRI study
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 mechanism of methadone in the treatment of HD patients.
万方数据
维普
