急性色氨酸、苯丙氨酸和酪氨酸剥夺对酒依赖者线索暴露诱导的饮酒迫促性的作用

EFFECTS OF ACUTE TYROSINE,TRYPTOPHAN,AND PHENYLALANINE DEPLETION TREATMENT ON CUE-INDUCED ALCOHOL URGING IN PATIENTS WITH ALCOHOL DEPENDENCE IN CHINA

目的:评价急性色氨酸、苯丙氨酸和酪氨酸剥夺(CMD)对酒依赖者线索暴露诱导的饮酒迫促性的作用。方法:采用随机双盲交叉对照的方法,选择符合ICD-10和DSM-Ⅳ诊断标准的男性酒依赖患者12名,并排除任一符合DSM-Ⅳ轴Ⅰ诊断的其他精神障碍。在签署知情同意书的情况下,每位受试者间隔至少7d分别在实验当天禁食的情况下给予含人体必需的16种氨基酸的氨基酸饮料(BLANCE)或缺失色氨酸、苯丙氨酸和酪氨酸的氨基酸饮料(CMD),实验的前一天低蛋白饮食,实验当天结束后给予高蛋白饮食。实验当天,在给予氨基酸饮料前后进行Tiffany饮酒迫促性量表、焦虑可视模拟标尺、抑郁可视模拟标尺、副反应量表测查以及血压、心率检测。给予氨基酸饮料6h后进行非酒精(纯净水)相关线索和酒精(白酒)相关线索暴露,并评价暴露前后饮酒迫促性、焦虑可视模拟标尺分、抑郁可视模拟标尺分和血压、心率的变化。结果:CMD组在非酒精相关线索和酒精相关线索暴露后饮酒意愿(Intention/desire to drinking)和舒张压均增加,差异具有显著性(P=0.0217,0.038),而BLANCE组在非酒精相关线索和酒精相关线索暴露后饮酒意愿、舒张压差异均无显著性。焦虑可视模拟标尺分、抑郁可视模拟标尺分、收缩压、心率在两组中的非酒精相关线索和酒精相关线索暴露前后的差异无显著性。在安全性方面,所有受试者中有1名出现腹泻,但是病人尚能耐受。其余少见的副反应主要有恶心、头晕、困倦等,皆为轻度或中度。结论:急性色氨酸、苯丙氨酸和酪氨酸剥夺(CMD)后酒依赖患者在非酒精和酒精相关线索暴露后的饮酒意愿增加,舒张压增高,但是对焦虑和抑郁情绪没有影响。口服氨基酸饮料的副反应少且轻微。

Background：The capacity of alcohol cues to precipitate the desire to drink may be an important determinant of relapse to alcohol use in recovering alcohol - dependent patients. Serotonin and dopamine may play a role in the craving induced by alcohol cues. Acute tryptophan （Trp）, phenylalanine/tyrosine （Phe/Tyr） depletion can canse attenuate of serotonin and dopamine synthesis in the human brain. There were no significant changes in the magnitude of cue -induced craving with active tryptophan depletion compared with placebo in abstinent alcoholic patients. But, compared to the Blancc mixture, Phe/Tyr - free, but not Trio - free, significantly decreased the ingestion of alcohol in healthy women. Objective： This study investigated whether attenuation of serotonin and dopamine synthesis via depletion of their precursors tryptophan, tyrosine, and phenylalanine reduced the magnitude of cue - induced alcohol urging for alcohol in recently abstinent alcoholic male individuals in China.