P300联合脑功能成像在定向毁损术治疗海洛因依赖中的应用(英文)

EFFECTS OF STEREOTACTICSURGERY ON EVENT-RELATED POTENTIALS P300 AND FUNCTIONAL NEUROIMAGING IN PATIENTS WITH HEROIN DEPENDENCE

目的:探讨立体定向毁损术治疗海洛因依赖患者手术前后P300的变化及与脑功能成像的关系。方法:对77例海洛因依赖者立体定向术术前和术后6～12月随访期间应用Keypoint电位仪和PET、fMRI进行检查,评估事件相关电位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:术前海洛因依赖患者及术后随访复吸者P300中的P3波潜伏期延长和波幅降低,与术后未复吸病例和正常对照组相比均存在显著性差异(P<0.01)。P3、PET、fMRI异常术前分别为63例、69例和54例,而随访期间分别为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,疗效良者有8例、5例和3例,复吸病例有15例、10例和8例;而且,fMRI异常病例PET和P3均异常,PET异常病例P3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不佳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 effects of stereotacticsurgery on event-related potentials （ERP） P300 and its relation to PET （positron emission tomography） and fMRl（functional magnetic resonance imaging） of brain in patients with heroin dependence. Methods： A retrospective study was carried on 77 patients with heroin dependence who were performed stereotacticsurgery. The data which were determined by keypoint potential meter, PET and fMRI at pre-operation and during 1-2 years follows-up were analyzed by statistics. The changes of ERP,MRI and PET as well as operative effect were evaluated and compared with normal control. Results： Com-pared with normal control and no-relapse cases, the P3 latency was significantly delayed and the P3 amplitude was lower both in pre-operative patients with heroin dependence and the replapser （P〈 0.01 ）. There were 63, 69 and 45 abnormal cases in ERP, PET and fMRI respectively at pre-operation, and during follow-up period there were 32, 18, 13 cases respectively, among which the cases with excellent therapeutic effect were 9, 3, 2 respectively, with fine therapeutic effect were 8, 5, 3 respectively and 15, 10 and 8 cases respectively in relapser. In addition, when fMRI was abnormal, PET and P3 were also abnormal; the same result was obtained between PET and P3. Tile comparison between the data of fMRI, PET and P3 in pre-operation and follow-up period, as well as that between the different therapeutic effect groups all have statistics significance（P〈0.05）. Conclusion： Cognitive impairment and functional abnormal area in brain were common occurrences in patients with heroin dependence and the cognitive function was improved after stereotacticsurgery. There were moderate correlations between cognitive impairment and functional neroimaging in pre- and post-operative patients with heroin dependence. Furthermore, the P300, PET and fMRI examination are valuable and objective in appraising the surgical effect in patients with heroin dependence.