P300和脑功能成像在定向术治疗海洛因依赖中的应用

Effect of event-related potentials P300 and functional neuroimaging in treating heroin dependence with stereotactic and functional neurosurgery

目的 探讨定向毁损术治疗海洛因依赖者手术前后P300和脑功能成像的变化及其关系.方法 对77例海洛因依赖者定向术术前和术后6-12个月随访期内进行P300和正电子发射断层摄影术（PET）、功能磁共振成像 （fMRI）检查,评估P300和脑功能成像的变化及其与手术疗效的关系,并与30名正常人比较,进行相关统计学分析.结果 海洛因依赖者术前及术后随访复吸者P300中的P3波潜伏期延长和波幅降低,与术后未复吸者和正常对照组比较均存在显著性差异（P＜ 0.01）.P300、PET、fMRI异常术前分别为63例、69例和54例,而随访时分别为32例、18例和13例,其中,疗效优者异常分别有9例、3例和2例,疗效差者有23例、15例和11例;而且,fMRI异常病例PET和P300均异常,PET异常病例P300均异常.各检查项目术前和随访时比较,及手术疗效优与手术疗效差组间比较均具有统计意义（P＜0.05）.结论海洛因依赖者存在一定认知障碍和脑功能异常区,定向手术可以改善患者认知功能.手术前后事件相关电位P300和PET、fMRI的改变具有一定相关性并可以作为评估海洛因依赖者手术治疗效果的客观指标.

Objective To explore the changes of event-related potentials （ERP） P300, positron emission tomography （PET）, functional magnetic resonance imaging （fMRI） and their relationship in patients with heroin dependence before and after stereotactic surgery. Methods A total of 77 patients with heroin dependence who were performed stereotactic surgery in 2004 were studied retrospectively. The data which were determined by ERP, PET and MRI at pre-operation and during 6 - 12 months of follow-up were analyzed respectively. The relationship between cognitive impairment and the changes of ERP, MRI and PET as well as operative effect were evaluated. Results Compared to normal control and non-relapse, the P3 latency was significantly delayed and its amplitude was lower both in pre-operative patients with heroin dependence and the relapse （P〈0.01）. Abnormal P300, PET and fMRI were presented in 63 cases, 69 cases, and 54 cases respectively at pre -operative, and in 32 cases,18 cases,13 cases respectively in follow - up period, among them, there were 9, 3, 2 cases in good therapeutic effect group and 23, 15, 11 cases in poor outcome group respectively. In addition, when fMRI was abnormal, PET and P300 were also abnormal and the same result obtained between PET and P300. Comparing the data of fMRI, PET and P300, there was significant difference between pre-operafion and follow-up period, as well as the different therapeutic effect groups （P〈0.05）.Conclusion Cognitive impairment is a contain occurrence in patients with heroin dependence. The cognitive function is inrproved after stereotactic surgery. There are moderate correlations between cognitive impairment and functional neuroimaging in pre- and post-operative patients with heroin dependence. Furthermore, The P300, PET and fMRI examination are valuable and objective targets for appraising the surgical effect in patients with heroin dependence.