长期戒断甲基苯丙胺依赖者大脑微观结构的影像学改变
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摘要
目的:探究长期戒断甲基苯丙胺依赖者大脑微观结构的影像改变机制。方法:对26例长期戒断依赖者(戒断时间长于14个月)和26例对照组进行认知执行功能测试和扩散张量成像(diffusion-tensor imaging,DTI)检查,利用基于体素的分析方法对两组的部分各向异性(fractional anisotropy,FA)和平均扩散率(mean diffusivity, MD)进行比较,获得组间参数差异脑区,将长期戒断甲基苯丙胺组异常脑区参数值与测试结果行Spearman相关分析。结果:长期戒断甲基苯丙胺组和对照组的认知执行功能测试结果差异无统计学意义(P>0.05);相比对照组,长期戒断甲基苯丙胺依赖组右侧楔前叶、背外侧额上回、距状裂周围皮质及左侧颞下回FA降低;右侧三角部额下回、楔前叶、后扣带回、颞中回、双侧枕中回、左侧顶上回及小脑半球8区MD升高。长期戒断甲基苯丙胺组右侧颞中回MD与数字符号60 s(r=–0.504)和120 s(r=–0.464)内完成个数均呈负相关。结论:甲基苯丙胺依赖者经长期戒断后多个脑区微结构仍存在异常,DTI可为长期戒断甲基苯丙胺依赖者脑微观结构异常提供影像学证据。
Objective: To explore the mechanism for changes in brain microstructure in long-term abstinent from methamphetamine-dependence by using the diffusion tensor imaging(DTI).Methods: A total of 26 patients with long-term abstinent methamphetamine-dependence, whose abstinence time more than 14 months, and 26 normal controls all underwent cognitive executive function tests and DTI scans. We used voxel-based analysis to compare the fractional anisotropy(FA) and mean diffusivity(MD) to obtain the abnormal brain regions of DTI parameters between the two groups. Spearman correlation analysis was used to explore the correlation between FA, MD of the brain regions with abnormal parameters and cognitive executive function tests.Results: There were no statistical differences in the cognitive executive function tests between the two groups(P>0.05). Compared with the normal control group, the long-term abstinent from methamphetamine-dependence group showed the decreased FA in the right precuneus, right superior frontal gyrus, right calcarine, left inferior temporal gyrus and the increased MD in the right triangular part of inferior frontal gyrus, right precuneus, right posterior cingulate, right middle temporal gyrus, bilateral middle occipital gyrus, left superior parietal lobule, and lobule VⅢ of cerebellar hemisphere. The MD values of the right middle temporal gyrus in the long-term abstinent group were negatively correlated with the number of completions within 60 seconds(r=–0.504) and within 120 seconds(r=–0.464).Conclusion: The DTI parameters in multiple brain regions from the methamphetaminedependence patients are still abnormal after a long-term abstinence. DTI can provide imaging evidence for brain microstructural abnormalities in long-term abstinent from methamphetaminedependence.
Objective: To explore the mechanism for changes in brain microstructure in long-term abstinent from methamphetamine-dependence by using the diffusion tensor imaging(DTI).Methods: A total of 26 patients with long-term abstinent methamphetamine-dependence, whose abstinence time more than 14 months, and 26 normal controls all underwent cognitive executive function tests and DTI scans. We used voxel-based analysis to compare the fractional anisotropy(FA) and mean diffusivity(MD) to obtain the abnormal brain regions of DTI parameters between the two groups. Spearman correlation analysis was used to explore the correlation between FA, MD of the brain regions with abnormal parameters and cognitive executive function tests.Results: There were no statistical differences in the cognitive executive function tests between the two groups(P>0.05). Compared with the normal control group, the long-term abstinent from methamphetamine-dependence group showed the decreased FA in the right precuneus, right superior frontal gyrus, right calcarine, left inferior temporal gyrus and the increased MD in the right triangular part of inferior frontal gyrus, right precuneus, right posterior cingulate, right middle temporal gyrus, bilateral middle occipital gyrus, left superior parietal lobule, and lobule VⅢ of cerebellar hemisphere. The MD values of the right middle temporal gyrus in the long-term abstinent group were negatively correlated with the number of completions within 60 seconds(r=–0.504) and within 120 seconds(r=–0.464).Conclusion: The DTI parameters in multiple brain regions from the methamphetaminedependence patients are still abnormal after a long-term abstinence. DTI can provide imaging evidence for brain microstructural abnormalities in long-term abstinent from methamphetaminedependence.
引文
[1]UNODC.World Drug Report 2014[R/OL].[2018-12-11].http://www.unodc.org/wdr2014.
[2]UNODC.World Drug Report 2016[R/OL].[2018-12-11].http://www.unodc.org/wdr2016.
[3]U.S.Department of State.2015 International Narcotis Contro Strategy Report[R/OL].[2018-12-11].https://www.state.gov/j/inl/rls/nrcrpt/2015/index.htm.
[4]Jan RK,Kydd RR,Russell BR.Functional and structural brain changes associated with methamphetamine abuse[J].Brain Sci2012,2(4):434-482.
[5]London ED,Kohno M,Morales A,et al.Chronic methamphetamine abuse and corticostriatal deficits revealed by neuroimaging[J].Brain Res,2014,1628:174-185.
[6]Ernst T,Chang L,Leonido-Yee M,et al.Evidence for long-term neurotoxicity associated with methamphetamine abuse:A 1H MRSstudy[J].Neurology,2000,54(6):1344-1349.
[7]Chang L,Alicata D,Ernst T,et al.Structural and metabolic brain changes in the striatum associated with methamphetamine abuse[J]Addiction,2010,102(s1):16-32.
[8]Cobb SJ,Paul WS,Matt GE,et al.Neurocognitive effects o methamphetamine:a critical rev iew and Meta-analysis[J]Neuropsychol Rev,2007,17(3):275-297.
[9]Chou YH,Su TP,Lu RB,et al.Dopamine transporters and cognitive function in methamphetamine abuser after a short abstinence:a SPECT study[J].Eur Neuropsychopharmacol,2007,17(1):46-52.
[10]Volkow ND,Linda C,Gene-Jack W,et al.Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence[J].J Neurosci,2001,21(23):9414-9418.
[11]Berman SM,Voy tek B,Mandelkern MA,et al.Changes in cerebral glucose metabolism during early abstinence from chronic methamphetamine abuse[J].Molec Psychiatry,2008,13(9):897-908.
[12]Gene-Jack W,Volkow ND,Linda C,et al.Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence[J].Am Psychiatry,2004,161(2):242-248.
[13]Liu JK,Yao L,Zhang WJ,et al.Dissociation of fractional anisotropy and resting-state functional connectivity alterations in antipsychoticnaive first-episode schizophrenia[J].Schizophr Res,2018,204:230-237.
[14]庄文旭,唐莺莹,钟娜,等.甲基苯丙胺依赖者的认知功能与白质微结构异常全脑弥散张量成像研究[J].中国药物依赖性杂志,2015,24(5):372-376.ZHUANG Wenxu,TANG Yingying,ZHONG Na,et al.The changes of cognitive function and white matter microstructure in methamphetamine abstinent:a whole-brain diffusion tensor imaging study[J].Chinese Journal of Drug Dependence,2015,24(5):372-376.
[15]In-Sung K,Yang-Tae K,Hui-Jin S,et al.Reduced corpus callosum white matter microstructural integrity revealed by diffusion tensor eigenvalues in abstinent methamphetamine addicts[J].Neurotoxicology,2009,30(2):209-213.
[16]Tobias MC,O'neill JM,Bartzokis G,et al.White-matter abnormalities in brain during early abstinence from methamphetamine abuse[J].Psychopharmacology,2010,209(1):13-24.
[17]Lederer K,Fouche JP,Wilson D,et al.Frontal white matter changes and aggression in methamphetamine dependence[J].Metab Brain Dis,2015,31(1):1-10.
[18]Zhuang W,Tang Y,Na Z,et al.Persistent microstructural deficits of internal capsule in one-year abstinent male methamphetamine users:a longitudinal diffusion tensor imaging study[J].J Neuroimmun Pharmacol,2016,11(3):523-530.
[19]Jenkinson M,Beckmann C,Behrens T,et al.FSL[J].Neuroimage,2012,62(2):782-790.
[20]Crean RD,Crane NA,Mason BJ.An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions[J].J Addict Med,2011,5(1):1-8.
[21]Plas VD,Ellen AA,Crone EA,et al.Executive control deficits in substance-dependent individuals:a comparison of alcohol,cocaine,and methamphetamine and of men and women[J].J Clin Exp Neuropsychol,2009,31(6):706-719.
[22]King G,Alicata D,Cloak C,et al.Neuropsychological deficits in adolescent methamphetamine abusers[J].Psychopharmacology,2010,212(2):243-249.
[23]Nir TM,Jahanshad N,Villalon-Reina JE,et al.Fractional anisotropy derived from the diffusion tensor distribution function boosts power to detect Alzheimer's disease deficits[J].Magn Reson Med,2017,78(6):2322-2333.
[24]Sintini I,Schwarz CG,Martin PR.Regional multimodal relationships between tau,hypo metabolism,atrophy,and fractional anisotropy in atypical Alzheimer's disease[J].Hum Brain Mapp,2019,40(5):1618-1631.
[25]Sasaki T,Pasternak O,Mayinger M,et al.Hockey concussion education project,part 3.white matter microstructure in ice hockey players with a history of concussion:a diffusion tensor imaging study[J].Neurosurgery,2014,120(4):882-890.
[26]Shenton ME,Hamoda HM,Schneiderman JS,et al.A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury[J].Brain Imaging Behav,2012,6(2):137-192.
[27]Kim SJ,Lyoo IK,Hwang J,et al.Prefrontal grey-matter changes in short-term and long-term abstinent methamphetamine abusers[J]Int J Neuropsychopharmacol,2006,9(2):221-228.
[28]张志学,李平,樊丽丹,等.长期戒断甲基苯丙胺依赖患者脑结构影像学改变[J].中南大学学报(医学版),2018,43(1):41-48.ZHANG Zhixue,LI Ping,FAN Lidan,et al.Change of brain structure imaging of long-term withdrawal of methamphetaminedependent patients[J].Journal of Central South University.Medica Science,2018,43(1):41-48.
[29]Volkow ND,Wang GJ,Smith L,et al.Recovery of dopamine transporters with methamphetamine detoxification is not linked to changes in dopamine release[J].Neuroimage,2015,121:20-28.
[30]Kish SJ,Fitzmaurice PS,Boileau I,et al.Brain serotonin transporter in human methamphetamine users[J].Psychopharmacology,2009202(4):649-661.
[31]Zhang ZZ,He L,Huang SC,et al.Alteration of brain structure with long-term abstinence of methamphetamine by voxel-based morphometry[J].Front Psychiatry,2018,9:722.
[32]Volkow ND,Fowler JS,Gene-Jack W.The addicted human brain insights from imaging studies[J].J Clin Invest,2003,111(10):1444-1451.
[33]Wiser AK,Andreasen NC,O'Leary DS,et al.Dysfunctional corticocerebellar circuits cause'cognitive dysmetria'in schizophrenia.[J]Neuroreport,1998,9(8):1895-1899.
[34]Ruby P,Sirigu A,Decety J.Distinct areas in parietal cortex involved in long-term and short-term action planning:a pet investigation[J]Cortex,2002,38(3):321-339.
[35]Yuan C,Zhu HR,Ren ZJ,et al.Precuneus-related regional and network functional deficits in social anxiety disorder:A resting-state functional MRI study[J].Comprehens Psychiatry,2017,82:22-29.
[36]Jiang G,Wen X,Qiu Y,et al.Disrupted topological organization in whole-brain functional networks of heroin-dependent individuals:a resting-state f MRI study[J].PLoS One,2013,8(12):e82715.
[37]Paulus MP,Tapert SF,Schuckit MA.Neural activation patterns o methamphetamine-dependent subjects during decision making predict relapse.[J].Arch Gen Psychiatry,2005,62(7):761-768.
[38]Thompson PM,Hayashi KM,Simon SL,et al.Structura abnormalities in the brains of human subjects who use methamphetamine[J].J Neurosci,2004,24(26):6028-6036.
[39]Yin JJ,Ma SH,Xu K,et al.Functional magnetic resonance imaging o methamphetamine craving[J].Clin Imaging,2012,36(6):695-701.
[40]Rony P,Hagar G,Roy M,et al.A neural substrate in the human hippocampus for linking successive events[J].Proc Nat Acad Sc USA,2010,107(13):6046-6051.
[41]Bartzokis G,Beckson M,Lu PH,et al.Age-related brain volume reductions in amphetamine and cocaine addicts and normal controls implications for addiction research[J].Psychiatry Res,2000,98(2)93-102.
[42]冯志娟.甲基苯丙胺依赖所致精神病性症状的脑结构影像学对照研究[D].长沙:中南大学,2014.FENG Zhijuan.A control study on brain structural imaging o psychotic symptoms caused by methamphetamine-dependence[D]Changsha:Central South University,2014.
[43]秦春莉,徐瑞雪.奥氮平联合曲唑酮对甲基苯丙胺所致精神障碍患者的应用价值[J].中国健康心理学杂志,2017,25(8)1138-1141.QIN Chunli,XU Ruixue.Application value of olanzapine combined with trazodone in the treatment of methamphetamine-induced mental disorder[J].China Journal of Health Psychology,201725(8):1138-1141.
[2]UNODC.World Drug Report 2016[R/OL].[2018-12-11].http://www.unodc.org/wdr2016.
[3]U.S.Department of State.2015 International Narcotis Contro Strategy Report[R/OL].[2018-12-11].https://www.state.gov/j/inl/rls/nrcrpt/2015/index.htm.
[4]Jan RK,Kydd RR,Russell BR.Functional and structural brain changes associated with methamphetamine abuse[J].Brain Sci2012,2(4):434-482.
[5]London ED,Kohno M,Morales A,et al.Chronic methamphetamine abuse and corticostriatal deficits revealed by neuroimaging[J].Brain Res,2014,1628:174-185.
[6]Ernst T,Chang L,Leonido-Yee M,et al.Evidence for long-term neurotoxicity associated with methamphetamine abuse:A 1H MRSstudy[J].Neurology,2000,54(6):1344-1349.
[7]Chang L,Alicata D,Ernst T,et al.Structural and metabolic brain changes in the striatum associated with methamphetamine abuse[J]Addiction,2010,102(s1):16-32.
[8]Cobb SJ,Paul WS,Matt GE,et al.Neurocognitive effects o methamphetamine:a critical rev iew and Meta-analysis[J]Neuropsychol Rev,2007,17(3):275-297.
[9]Chou YH,Su TP,Lu RB,et al.Dopamine transporters and cognitive function in methamphetamine abuser after a short abstinence:a SPECT study[J].Eur Neuropsychopharmacol,2007,17(1):46-52.
[10]Volkow ND,Linda C,Gene-Jack W,et al.Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence[J].J Neurosci,2001,21(23):9414-9418.
[11]Berman SM,Voy tek B,Mandelkern MA,et al.Changes in cerebral glucose metabolism during early abstinence from chronic methamphetamine abuse[J].Molec Psychiatry,2008,13(9):897-908.
[12]Gene-Jack W,Volkow ND,Linda C,et al.Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence[J].Am Psychiatry,2004,161(2):242-248.
[13]Liu JK,Yao L,Zhang WJ,et al.Dissociation of fractional anisotropy and resting-state functional connectivity alterations in antipsychoticnaive first-episode schizophrenia[J].Schizophr Res,2018,204:230-237.
[14]庄文旭,唐莺莹,钟娜,等.甲基苯丙胺依赖者的认知功能与白质微结构异常全脑弥散张量成像研究[J].中国药物依赖性杂志,2015,24(5):372-376.ZHUANG Wenxu,TANG Yingying,ZHONG Na,et al.The changes of cognitive function and white matter microstructure in methamphetamine abstinent:a whole-brain diffusion tensor imaging study[J].Chinese Journal of Drug Dependence,2015,24(5):372-376.
[15]In-Sung K,Yang-Tae K,Hui-Jin S,et al.Reduced corpus callosum white matter microstructural integrity revealed by diffusion tensor eigenvalues in abstinent methamphetamine addicts[J].Neurotoxicology,2009,30(2):209-213.
[16]Tobias MC,O'neill JM,Bartzokis G,et al.White-matter abnormalities in brain during early abstinence from methamphetamine abuse[J].Psychopharmacology,2010,209(1):13-24.
[17]Lederer K,Fouche JP,Wilson D,et al.Frontal white matter changes and aggression in methamphetamine dependence[J].Metab Brain Dis,2015,31(1):1-10.
[18]Zhuang W,Tang Y,Na Z,et al.Persistent microstructural deficits of internal capsule in one-year abstinent male methamphetamine users:a longitudinal diffusion tensor imaging study[J].J Neuroimmun Pharmacol,2016,11(3):523-530.
[19]Jenkinson M,Beckmann C,Behrens T,et al.FSL[J].Neuroimage,2012,62(2):782-790.
[20]Crean RD,Crane NA,Mason BJ.An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions[J].J Addict Med,2011,5(1):1-8.
[21]Plas VD,Ellen AA,Crone EA,et al.Executive control deficits in substance-dependent individuals:a comparison of alcohol,cocaine,and methamphetamine and of men and women[J].J Clin Exp Neuropsychol,2009,31(6):706-719.
[22]King G,Alicata D,Cloak C,et al.Neuropsychological deficits in adolescent methamphetamine abusers[J].Psychopharmacology,2010,212(2):243-249.
[23]Nir TM,Jahanshad N,Villalon-Reina JE,et al.Fractional anisotropy derived from the diffusion tensor distribution function boosts power to detect Alzheimer's disease deficits[J].Magn Reson Med,2017,78(6):2322-2333.
[24]Sintini I,Schwarz CG,Martin PR.Regional multimodal relationships between tau,hypo metabolism,atrophy,and fractional anisotropy in atypical Alzheimer's disease[J].Hum Brain Mapp,2019,40(5):1618-1631.
[25]Sasaki T,Pasternak O,Mayinger M,et al.Hockey concussion education project,part 3.white matter microstructure in ice hockey players with a history of concussion:a diffusion tensor imaging study[J].Neurosurgery,2014,120(4):882-890.
[26]Shenton ME,Hamoda HM,Schneiderman JS,et al.A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury[J].Brain Imaging Behav,2012,6(2):137-192.
[27]Kim SJ,Lyoo IK,Hwang J,et al.Prefrontal grey-matter changes in short-term and long-term abstinent methamphetamine abusers[J]Int J Neuropsychopharmacol,2006,9(2):221-228.
[28]张志学,李平,樊丽丹,等.长期戒断甲基苯丙胺依赖患者脑结构影像学改变[J].中南大学学报(医学版),2018,43(1):41-48.ZHANG Zhixue,LI Ping,FAN Lidan,et al.Change of brain structure imaging of long-term withdrawal of methamphetaminedependent patients[J].Journal of Central South University.Medica Science,2018,43(1):41-48.
[29]Volkow ND,Wang GJ,Smith L,et al.Recovery of dopamine transporters with methamphetamine detoxification is not linked to changes in dopamine release[J].Neuroimage,2015,121:20-28.
[30]Kish SJ,Fitzmaurice PS,Boileau I,et al.Brain serotonin transporter in human methamphetamine users[J].Psychopharmacology,2009202(4):649-661.
[31]Zhang ZZ,He L,Huang SC,et al.Alteration of brain structure with long-term abstinence of methamphetamine by voxel-based morphometry[J].Front Psychiatry,2018,9:722.
[32]Volkow ND,Fowler JS,Gene-Jack W.The addicted human brain insights from imaging studies[J].J Clin Invest,2003,111(10):1444-1451.
[33]Wiser AK,Andreasen NC,O'Leary DS,et al.Dysfunctional corticocerebellar circuits cause'cognitive dysmetria'in schizophrenia.[J]Neuroreport,1998,9(8):1895-1899.
[34]Ruby P,Sirigu A,Decety J.Distinct areas in parietal cortex involved in long-term and short-term action planning:a pet investigation[J]Cortex,2002,38(3):321-339.
[35]Yuan C,Zhu HR,Ren ZJ,et al.Precuneus-related regional and network functional deficits in social anxiety disorder:A resting-state functional MRI study[J].Comprehens Psychiatry,2017,82:22-29.
[36]Jiang G,Wen X,Qiu Y,et al.Disrupted topological organization in whole-brain functional networks of heroin-dependent individuals:a resting-state f MRI study[J].PLoS One,2013,8(12):e82715.
[37]Paulus MP,Tapert SF,Schuckit MA.Neural activation patterns o methamphetamine-dependent subjects during decision making predict relapse.[J].Arch Gen Psychiatry,2005,62(7):761-768.
[38]Thompson PM,Hayashi KM,Simon SL,et al.Structura abnormalities in the brains of human subjects who use methamphetamine[J].J Neurosci,2004,24(26):6028-6036.
[39]Yin JJ,Ma SH,Xu K,et al.Functional magnetic resonance imaging o methamphetamine craving[J].Clin Imaging,2012,36(6):695-701.
[40]Rony P,Hagar G,Roy M,et al.A neural substrate in the human hippocampus for linking successive events[J].Proc Nat Acad Sc USA,2010,107(13):6046-6051.
[41]Bartzokis G,Beckson M,Lu PH,et al.Age-related brain volume reductions in amphetamine and cocaine addicts and normal controls implications for addiction research[J].Psychiatry Res,2000,98(2)93-102.
[42]冯志娟.甲基苯丙胺依赖所致精神病性症状的脑结构影像学对照研究[D].长沙:中南大学,2014.FENG Zhijuan.A control study on brain structural imaging o psychotic symptoms caused by methamphetamine-dependence[D]Changsha:Central South University,2014.
[43]秦春莉,徐瑞雪.奥氮平联合曲唑酮对甲基苯丙胺所致精神障碍患者的应用价值[J].中国健康心理学杂志,2017,25(8)1138-1141.QIN Chunli,XU Ruixue.Application value of olanzapine combined with trazodone in the treatment of methamphetamine-induced mental disorder[J].China Journal of Health Psychology,201725(8):1138-1141.