), 林志为3, 王孟成1, 杨文登1, 麻彦坤1(), 曾红1() 1广州大学教育学院心理系, 广州 510006
2清华大学社会科学学院心理学系, 北京 100084
3广东省第二强制隔离戒毒所, 佛山 528135
收稿日期:2021-03-22出版日期:2021-08-25发布日期:2021-06-25通讯作者:王鹏飞,麻彦坤,曾红E-mail:zhh0791@163.com;ykma@gzhu.edu.cn;pwang@gzhu.edu.cn基金资助:*国家自然科学基金项目(31771214);广东省第二强制隔离戒毒所与广州大学合作项目《戒毒人员预防复吸训练》Structural and functional characteristics of impulsive-related brain regions in heroin addicts with long-term withdrawal
CAI Huiyan1, MIAO Xin2, WANG Pengfei1(), LIN Zhiwei3, WANG Mengcheng1, YANG Wendeng1, MA Yankun1(), ZENG Hong1() 1Department of Psychology, Guangzhou University, Guangzhou 510006, China
2Department of Psychology, School of Social Sciences, Tsinghua University, Beijing 100084, China
3Guangdong Secondary Compulsory Substance Rehabilitation Center, Foshan 528135, China
Received:2021-03-22Online:2021-08-25Published:2021-06-25Contact:WANG Pengfei,MA Yankun,ZENG Hong E-mail:zhh0791@163.com;ykma@gzhu.edu.cn;pwang@gzhu.edu.cn摘要/Abstract
摘要： 冲动性是药物成瘾者的典型特征, 它既包含了抑制控制成瘾者药物使用的力量, 也包含驱动成瘾者使用药物的成分, 两者不平衡导致冲动性用药行为。海洛因成瘾者本身具有冲动性人格特质, 长时间的海洛因使用又会造成成瘾者冲动性相关的大脑结构与功能的异常。目前难以确定戒断后, 冲动性及相关的大脑结构与功能是否还呈异常状态。本研究采用基于体素的形态学分析、低频振幅、局部一致性和功能连接方法, 以35例海洛因成瘾戒断者和无任何成瘾史的健康个体26人为研究对象, 探索在长期戒断后, 海洛因成瘾者与其冲动性相关的驱动、控制系统脑网络的结构和功能情况。结果显示, 相比对照组, 戒断组灰质总体积及右内侧额上回的灰质体积显著减小, 右侧颞中回和左内侧旁扣带回的灰质体积随用药总量的增加而降低; 右侧眶部额下回与尾状核功能连接显著增强, 右侧颞中回和左侧中央前回功能连接显著降低; 右眶额中回的ReHo值、右眶额下回和左海马体的ALFF值比对照组显著更低, 而右中央后回的ReHo值显著更高。这些脑区的状况与冲动性的神经基础相吻合, 说明海洛因成瘾戒断者在戒断44个月, 奖赏、凸显、习惯性行为等网络系统仍然呈现异常状态, 且与成瘾药物使用总量有关。这些异常可能是成瘾冲动性的驱动力的神经基础, 可以作为解释成瘾者戒断后容易复吸的因素之一。
图/表 18
表1海洛因成瘾完全戒断组和美沙酮戒断组基本信息及脑指标(M ± SD)
| 基本信息 | 完全戒断组(23) | 美沙酮戒断组(12) | t | p | Cohen'sd |
|---|---|---|---|---|---|
| 年龄(岁) | 40.20 ± 3.54 | 41.82 ± 3.69 | -1.25 | 0.22 | -0.45 |
| 受教育程度(年) | 9.04 ± 1.40 | 9.45 ± 1.04 | -0.88 | 0.38 | -0.33 |
| 香烟用量/天(根) | 12.99 ± 5.42 | 15.48 ± 7.76 | -1.11 | 0.27 | -0.41 |
| 酒精用量/天(ml) | 18.40 ± 10.02 | 18.48 ± 12.42 | -0.02 | 0.98 | -0.01 |
| 戒断前海洛因用量/天(g) | 0.55 ± 0.28 | 0.65 ± 0.27 | -0.78 | 0.44 | -0.36 |
| 戒断前用量海洛因/月(g) | 16.34 ± 8.31 | 18.75 ± 8.10 | -0.78 | 0.44 | -0.29 |
| 用药时长(月) | 200.76 ± 40.84 | 223.80 ± 56.86 | -1.35 | 0.19 | -0.47 |
| 使用总量(g) | 3417.44 ± 2102.84 | 4107.75 ± 2102.78 | -0.88 | 0.39 | -0.33 |
| 戒断时长(月) | 42.43 ± 6.48 | 44.25 ± 5.28 | -0.83 | 0.41 | -0.31 |
| 灰质总量(mm3) | 637.39 ± 63.43 | 664.90 ± 47.69 | -1.24 | 0.23 | -0.49 |
| 白质总量(mm3) | 535.40 ± 59.03 | 537.40 ± 41.85 | -0.10 | 0.92 | -0.03 |
| 脑脊液总量(mm3) | 234.49 ± 30.49 | 232.02 ± 23.93 | 0.23 | 0.82 | 0.09 |
| 颅内总体积(mm3) | 1407.28 ± 132.81 | 1434.33 ± 97.14 | -0.58 | 0.56 | -0.23 |
表1海洛因成瘾完全戒断组和美沙酮戒断组基本信息及脑指标(M ± SD)
| 基本信息 | 完全戒断组(23) | 美沙酮戒断组(12) | t | p | Cohen'sd |
|---|---|---|---|---|---|
| 年龄(岁) | 40.20 ± 3.54 | 41.82 ± 3.69 | -1.25 | 0.22 | -0.45 |
| 受教育程度(年) | 9.04 ± 1.40 | 9.45 ± 1.04 | -0.88 | 0.38 | -0.33 |
| 香烟用量/天(根) | 12.99 ± 5.42 | 15.48 ± 7.76 | -1.11 | 0.27 | -0.41 |
| 酒精用量/天(ml) | 18.40 ± 10.02 | 18.48 ± 12.42 | -0.02 | 0.98 | -0.01 |
| 戒断前海洛因用量/天(g) | 0.55 ± 0.28 | 0.65 ± 0.27 | -0.78 | 0.44 | -0.36 |
| 戒断前用量海洛因/月(g) | 16.34 ± 8.31 | 18.75 ± 8.10 | -0.78 | 0.44 | -0.29 |
| 用药时长(月) | 200.76 ± 40.84 | 223.80 ± 56.86 | -1.35 | 0.19 | -0.47 |
| 使用总量(g) | 3417.44 ± 2102.84 | 4107.75 ± 2102.78 | -0.88 | 0.39 | -0.33 |
| 戒断时长(月) | 42.43 ± 6.48 | 44.25 ± 5.28 | -0.83 | 0.41 | -0.31 |
| 灰质总量(mm3) | 637.39 ± 63.43 | 664.90 ± 47.69 | -1.24 | 0.23 | -0.49 |
| 白质总量(mm3) | 535.40 ± 59.03 | 537.40 ± 41.85 | -0.10 | 0.92 | -0.03 |
| 脑脊液总量(mm3) | 234.49 ± 30.49 | 232.02 ± 23.93 | 0.23 | 0.82 | 0.09 |
| 颅内总体积(mm3) | 1407.28 ± 132.81 | 1434.33 ± 97.14 | -0.58 | 0.56 | -0.23 |
表2海洛因成瘾戒断组和对照组基本信息(M ± SD)
| 基本信息 | 戒断组(35) | 对照组(26) | t | p | Cohen'sd |
|---|---|---|---|---|---|
| 年龄(岁) | 40.69 ± 3.61 | 42.31 ± 8.45 | -0.90 | 0.37 | 0.25 |
| 受教育程度(年) | 9.17 ± 1.30 | 10.50 ± 1.55 | -3.48 | 0.00 | 0.93 |
| 香烟用量/天(根) | 13.81 ± 8.27 | 11.43 ± 9.72 | 0.99 | 0.33 | 0.26 |
| 酒精用量/天(ml) | 19.74 ± 13.93 | 8.84 ± 8.70 | 3.45 | 0.00 | 0.94 |
| 戒断前海洛因用量/天(g) | 0.57 ± 0.27 | N/A | |||
| 戒断前海洛因用量/月(g) | 17.03 ± 8.21 | N/A | |||
| 用药时长(月) | 207.34 ± 45.65 | N/A | |||
| 使用总量(g) | 3614.67 ± 2095.69 | N/A | |||
| 戒断时长(月) | 43.55 ± 6.59 | N/A |
表2海洛因成瘾戒断组和对照组基本信息(M ± SD)
| 基本信息 | 戒断组(35) | 对照组(26) | t | p | Cohen'sd |
|---|---|---|---|---|---|
| 年龄(岁) | 40.69 ± 3.61 | 42.31 ± 8.45 | -0.90 | 0.37 | 0.25 |
| 受教育程度(年) | 9.17 ± 1.30 | 10.50 ± 1.55 | -3.48 | 0.00 | 0.93 |
| 香烟用量/天(根) | 13.81 ± 8.27 | 11.43 ± 9.72 | 0.99 | 0.33 | 0.26 |
| 酒精用量/天(ml) | 19.74 ± 13.93 | 8.84 ± 8.70 | 3.45 | 0.00 | 0.94 |
| 戒断前海洛因用量/天(g) | 0.57 ± 0.27 | N/A | |||
| 戒断前海洛因用量/月(g) | 17.03 ± 8.21 | N/A | |||
| 用药时长(月) | 207.34 ± 45.65 | N/A | |||
| 使用总量(g) | 3614.67 ± 2095.69 | N/A | |||
| 戒断时长(月) | 43.55 ± 6.59 | N/A |
表3戒断组与对照组各脑指标的双样本t检验结果
| 基本信息 | 戒断组(35) | 对照组(26) | t | p | Cohen'sd |
|---|---|---|---|---|---|
| 灰质总量(mm3) | 625.41 ± 36.41 | 654.26 ± 63.43 | -2.23 | 0.03 | 0.56 |
| 白质总量(mm3) | 523.02 ± 51.08 | 540.36 ± 9.03 | -1.28 | 0.21 | 0.47 |
| 脑脊液总量(mm3) | 231.95 ± 18.98 | 234.16 ± 30.49 | -0.34 | 0.73 | 0.09 |
| 脑实质占比(%) | 0.83 ± 0.01 | 0.84 ± 0.02 | -1.24 | 0.22 | 0.63 |
| 颅内总体积(mm3) | 1380.38 ± 84.65 | 1428.79 ± 132.81 | -1.74 | 0.09 | 0.43 |
表3戒断组与对照组各脑指标的双样本t检验结果
| 基本信息 | 戒断组(35) | 对照组(26) | t | p | Cohen'sd |
|---|---|---|---|---|---|
| 灰质总量(mm3) | 625.41 ± 36.41 | 654.26 ± 63.43 | -2.23 | 0.03 | 0.56 |
| 白质总量(mm3) | 523.02 ± 51.08 | 540.36 ± 9.03 | -1.28 | 0.21 | 0.47 |
| 脑脊液总量(mm3) | 231.95 ± 18.98 | 234.16 ± 30.49 | -0.34 | 0.73 | 0.09 |
| 脑实质占比(%) | 0.83 ± 0.01 | 0.84 ± 0.02 | -1.24 | 0.22 | 0.63 |
| 颅内总体积(mm3) | 1380.38 ± 84.65 | 1428.79 ± 132.81 | -1.74 | 0.09 | 0.43 |
图1戒断组与对照组在右侧内侧额上回的双样本t检验结果
图1戒断组与对照组在右侧内侧额上回的双样本t检验结果表4HAG灰质体积与用药总量相关的脑区
| 脑区名称 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| x | y | z | |||||
| 颞中回 | R | 2340 | 56 | -59 | -5 | -4.35 | < 0.01 |
| 内侧和旁扣带回 | L | 3640 | -8 | -38 | 33 | -4.84 | < 0.01 |
表4HAG灰质体积与用药总量相关的脑区
| 脑区名称 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| x | y | z | |||||
| 颞中回 | R | 2340 | 56 | -59 | -5 | -4.35 | < 0.01 |
| 内侧和旁扣带回 | L | 3640 | -8 | -38 | 33 | -4.84 | < 0.01 |
图2HAG右侧颞中回灰质体积与用药总量的相关图
图2HAG右侧颞中回灰质体积与用药总量的相关图
图3HAG左侧内侧和旁扣带回灰质体积与用药总量的相关图
图3HAG左侧内侧和旁扣带回灰质体积与用药总量的相关图表5戒断组相比对照组局部一致性的双样本t检验
| 解剖脑区 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| x | y | z | |||||
| HAG < HCG | |||||||
| 额中回 | R | 676 | 12 | 57 | -9 | -6.28 | < 0.01 |
| HAG > HCG | |||||||
| 中央后回 | R | 204 | 33 | -30 | 54 | 3.54 | < 0.01 |
表5戒断组相比对照组局部一致性的双样本t检验
| 解剖脑区 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| x | y | z | |||||
| HAG < HCG | |||||||
| 额中回 | R | 676 | 12 | 57 | -9 | -6.28 | < 0.01 |
| HAG > HCG | |||||||
| 中央后回 | R | 204 | 33 | -30 | 54 | 3.54 | < 0.01 |
图4戒断组与对照组在右侧额中回的双样本t检验图
图4戒断组与对照组在右侧额中回的双样本t检验图
图5戒断组与对照组在右侧中央后回的双样本t检验图
图5戒断组与对照组在右侧中央后回的双样本t检验图表6戒断者相比对照组ALFF的双样本t检验
| 脑区名称 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| X | Y | Z | |||||
| HAG < HCG | |||||||
| 眶部额下回 | R | 389 | 15 | 60 | -6 | -5.30 | < 0.01 |
| 海马体 | L | 66 | -9 | -3 | -15 | -5.38 | < 0.01 |
表6戒断者相比对照组ALFF的双样本t检验
| 脑区名称 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| X | Y | Z | |||||
| HAG < HCG | |||||||
| 眶部额下回 | R | 389 | 15 | 60 | -6 | -5.30 | < 0.01 |
| 海马体 | L | 66 | -9 | -3 | -15 | -5.38 | < 0.01 |
图6戒断组与对照组在右眶部额下回的双样本t检验图
图6戒断组与对照组在右眶部额下回的双样本t检验图
图7戒断组与对照组在左海马的双样本t检验图
图7戒断组与对照组在左海马的双样本t检验图表7戒断组与对照组以右眶部额下回为感兴趣区的功能连接双样本t检验结果
| 解剖脑区 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| X | Y | Z | |||||
| HAG > HCG | |||||||
| 尾状核 | R | 192 | 27 | 12 | -9 | 4.61 | < 0.01 |
| HAG < HCG | |||||||
| 颞中回 | R | 205 | 33 | 3 | -39 | -4.51 | < 0.01 |
| 中央前回 | L | 853 | -30 | -21 | 60 | -4.17 | < 0.01 |
表7戒断组与对照组以右眶部额下回为感兴趣区的功能连接双样本t检验结果
| 解剖脑区 | L/R | Cluster size | MNI coordinates | t | pAlphaSim校正 | ||
|---|---|---|---|---|---|---|---|
| X | Y | Z | |||||
| HAG > HCG | |||||||
| 尾状核 | R | 192 | 27 | 12 | -9 | 4.61 | < 0.01 |
| HAG < HCG | |||||||
| 颞中回 | R | 205 | 33 | 3 | -39 | -4.51 | < 0.01 |
| 中央前回 | L | 853 | -30 | -21 | 60 | -4.17 | < 0.01 |
图8戒断组与对照组以右眶部额下回为感兴趣区的全脑功能连接双样本t检验图
图8戒断组与对照组以右眶部额下回为感兴趣区的全脑功能连接双样本t检验图
图9戒断组与对照组右侧眶部额下回与右侧尾状核功能连接的双样本t检验图
图9戒断组与对照组右侧眶部额下回与右侧尾状核功能连接的双样本t检验图
图10戒断组与对照组右眶部额下回与左中央前回功能连接的双样本t检验图
图10戒断组与对照组右眶部额下回与左中央前回功能连接的双样本t检验图
图11戒断组右眶部额下回-右颞中回功能连接强度与用药时间的相关
图11戒断组右眶部额下回-右颞中回功能连接强度与用药时间的相关参考文献 55
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