丁丙诺啡舌下片合并东莨菪碱、异丙嗪药物依赖者脑灰质密度的研究

Longitudinal Observation on Brain Structure in Patients with Dependence on Sublingual Buprenorphine,Scopolamine and Promethazine in Different Stages of Abstinence

目的:观察盐酸丁丙诺啡舌下片(sublingual buprenorphine)合并东莨菪碱(scopolamine)、异丙嗪(promet鄄hazine)药物依赖者(简称BSP依赖者)脑灰质密度的变化,并比较其与海洛因依赖者脑结构损害的异同。方法:采用基于像素的形态学测量(voxel-based morphometry,VBM)方法对16例BSP依赖者、20例海洛因依赖者停药第3天、第2个月的脑灰质密度进行了组间以及组内自身前后对比研究,并设立18例正常对照者。结果:与正常对照组相比,BSP滥用可导致成瘾者大脑广泛性脑结构损害,表现为灰质密度下降,涉及额叶、顶叶、颞叶、枕叶、岛叶、纹状体等脑区;与海洛因依赖组相比,停药3天BSP依赖组脑区灰质受损程度重于海洛因依赖组,且随着停药时间的延长,BSP依赖者灰质恢复进程慢于海洛因依赖者。结论:BSP滥用可造成依赖者广泛性、严重的脑皮质结构异常,主要集中在额叶等与成瘾关系密切的脑区。BSP滥用较海洛因更易损伤大脑皮质神经元,且大脑灰质恢复进程慢于海洛因依赖组,这提示BSP滥用对大脑皮质神经元的损害在短时间难以恢复。

Objective： Recently,an intravenous abuse of buprenorphine tablets,scopolamine and promethazine solution（BSP） has been emerging among heroin-dependent individuals in some areas of Southern China.The aim of this study was to explore the brain structural pathological changes in the patients with BSP dependence,by three dimensional MRI（3D） and compare their impairment of the brain with that of the heroin addicts.Methods： BSP-dependent patients（n=16）,heroin-dependent individuals（n=20） and age/eduction-matched healthy control subjects（n=18） were assessed by 3D during resting state.Patients with BSP and heroin dependence were examined by MRI scanning after 3 days and 2 months of abstinence,while control subjects were tested only once.Results： Compared with health controls,GMD was significantly lower in frontal,parietal,temporal and occipital lobes and striatum in the BSP addicts after 3-day withdrawal.Compared with heroin-dependent subjects,there were some brain regions showing significantly lower GMD in BSP addicts after 3-day withdrawal.Longitudinally,BSP addicts recovered significantly slower in GMD than heroin addicts.Conclusion： GMD lesions were widespread in patients of BSP dependence.Decreased GMD in frontal,parietal cortex and striatum may contribute to neuropsychological deficits frequently observed in BSP addicts.That GMD lesions were heavier in BSP dependent subjects than those in heroin addicts suggests that cortical neuron may be vulnerable to BSP-associated brain structural changes.BSP dependent subjects＇ recovering significantly slower in GMD than heroin addicts suggests that rehabilitation time should be further prolonged for BSP addicts.