环境线索诱导海洛因依赖者心理渴求的SPECT研究

The Regional Cerebral Blood Flow and Cue-induced Heroin Craving

目的 :研究与海洛因相关的环境线索诱导急性脱毒后海洛因依赖者的心理渴求及其局部脑血流灌注的变化特征。方法 :选择脱毒治疗一个月后海洛因依赖者 ,给于与海洛因相关的环境刺激 (暴露 ) 15分钟 ,在海洛因环境暴露前后分别评定心理渴求量表和汉米尔顿焦虑量表 ,同时采用单光子发射计算机断层扫描 (SPECT)测量局部脑血流灌注 (rBCF)的变化。结果 :暴露海洛因相关的环境可增加病人对药物的心理渴求 :1)使脱毒海洛因依赖者的心理渴求量表评分增加 ,与暴露前相比差异有显著性 (t =3 2 1P <0 0 5 ) ;2 )海洛因相关的环境刺激可以增加病人的焦虑情绪 ,表现为汉米尔顿焦虑量表总评分增高 ,(t =3 1,P <0 0 1)特别是躯体焦虑因子评分增高更为明显 (t =2 98,P <0 0 1) ;3 )海洛因的环境刺激明显增加额叶 ,颞叶皮层及杏仁核等脑区的局部脑血流 ,而其他脑区如顶叶、枕叶、扣带回及基底节等区域的脑血流灌注则无明显的变化。结论 :海洛因相关的环境可以诱导吸毒者对海洛因的心理渴求 ,是脱毒后发生复吸的主要因素之一 ,额叶、颞叶皮层及杏仁核等脑区参与了环境线索诱导复吸的神经生物过程。阻断药物相关的环境线索的刺激可以作为预防吸毒者脱毒后的再次复吸行为的手段之一。

Objective:to explore behavioral and neurological mechanism of cue-induced heroin craving in heroin dependents Method: Seventeen heroin dependents after detoxification for more than one month were enrolled All subjects were exposed to heroin related cues for 15 min Psychological craving was rated, rCBF (regional cerebral blood flow) were measured by SPECT before and after exposure Anxiety of subjects was also assessed with HAMA Result: Craving was observed in subjects after they were exposed to the cue It could also increase anxiety in subjects, particularly physical anxiety At the same time, the rCBF in frontal, temporal cortex and amygdala increased significantly Conclusion: Drug related cues play a critical role in relapse of dependence, and frontal, temporal cortex and amygdala are involved in these process