高频重复经颅磁刺激改善甲基苯丙胺成瘾者的渴求和决策障碍

High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex modulates craving and decision-making deficits in patients with methamphetamine addiction

目的观察高频重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)对甲基苯丙胺(methamphetamine,MA)成瘾者的渴求和决策障碍的效果。方法选取蚌埠强制隔离戒毒所64例MA依赖者,随机分为MA实验组(34例)和MA对照组(30例),MA实验组接受高频rTMS刺激左侧背外侧前额叶治疗,MA对照组接受类似rTMS的伪刺激治疗,每周3次,治疗周期为4周,在治疗前及治疗后分别采用爱荷华博弈测验(iowa gambling task,IGT)和视觉模拟标尺(visual analogue scale,VAS)评估MA成瘾者的渴求和决策能力,采用SPSS 23.0对数据进行统计分析。结果治疗前MA实验组和MA对照组VAS评分差异无统计学意义(t=-0.20,P=0.84),治疗4周后MA实验组和MA对照组在治疗前后分数差值差异有统计学意义(t=2.02,P=0.048);治疗前MA实验组和MA对照组IGT净分数总分、5个模块组块(block)净分数差异无统计学意义,在治疗后净分数总分和第2,4,5模块的净分数较治疗前显著增高,在治疗后净分数差值上和MA对照组差异有统计学意义(t=2.62,P=0.011;t=1.00,P=0.039;t=3.08,P=0.003;t=2.79,P=0.007)。结论高频rTMS可显著改善MA依赖者的认知决策能力与心理渴求状况,安全性高,为MA滥用的有效防治提供科学依据。

Objective:To explore drug craving and cognitive decision-making deficits of high frequency repetitive transcranial magnetic stimulation in methamphetamine use disorder.Methods:Sixty-four methamphetamine use disorders according to DSM-5 were randomized to undergo 10-Hz rTMS(34 patients)and sham rTMS(30 patients)to the left prefrontal cortex.Visual analog scale(VAS)and Iowa game test(IGT)were used to evaluate their drug craving and cognitive decision-making deficits before and after treatment,and SPSS 23.0 was used for data analysis.Results:Before treatment,there was no difference in VAS scores between MA group and sham MA group(t=﹣0.20,pP=0.84).After 4 weeks treatment,VAS scores of MA group were significantly lower than those of the sham MA group(t=2.02,P=0.048).The net score of IGT in the two groups showed that there was no significant difference between MA group and sham MA group before treatment,and the net score of IGT MA group after treatment was better than that before treatment in the aggregate score of IGT and block2 and block 4 and block 5(t=2.62,P=0.011;t=1.00,P=0.039;t=3.08,P=0.003;t=2.79,P=0.007).Conclusion:High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex modulates can improve decision-making deficits and drug craving in patients with methamphetamine addiction,which provides scientific basis for effective prevention and treatment of methamphetamine abuse.