甲基苯丙胺滥用与依赖的相关影像学研究进展
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摘要
长期滥用甲基苯丙胺(methamphetamine,MA)可引起患者脑内血流灌注、葡萄糖代谢、某些生物化学物质甚至局部脑结构的改变。本文主要对MA滥用与依赖引起的脑结构及功能改变的影像学表现进行综述,以了解MA滥用与依赖者脑结构及功能的改变与其认知和动机功能损害之间的关系。主要总结利用单光子发射计算机断层成像术-计算机断层扫描术(single-photon emission computed tomography-computed tomography,SPECT-CT)、正电子发射断层成像术-计算机断层扫描仪(positron emission tomography-computed tomography,PET-CT)、磁共振成像(magnetic resonance imaging,MRI)、功能性磁共振成像(functional magnetic resonance imaging,fMRI)、质子磁共振波谱(proton magnetic resonance spectroscopy,proton MRS)影像技术观察MA滥用与依赖引起的脑解剖结构改变,以及在生理状态下观察脑内血流灌注及葡萄糖代谢的变化,研究参与甲基苯丙胺依赖的脑区、核团,并且MRS能够检测出脑内某些神经化学物质的变化。在临床工作中联合应用影像检查技术,能够监测MA滥用与依赖期间大脑的变化及预测复吸的可能性,对临床医师的治疗决策起重要作用。
Amphetamines(mainly MA and amphetamine)are the second most prevalent psychoactive substances.In recent years,the abuse and dependence of MA has also became increasingly serious in China.The abuse and dependence of MA has became a global public health problem,which not only has a serious social impact but also occupies a significant amount of medical resources.Despite treating MA out of order,the mortality and relapse rate remains very high.Chronic abuse of MA can cause change in regional cerebral blood flow,glucose metabolism,certain biochemical substances,and even local brain structures.This paper presents a brief overview of the imaging findingsof brain anatomical and functional change caused by the abuse and dependence of MA,which will help us understand the mechanism of MA dependence better.By searching a large number of the latest literatures,the paper summarizes the brain anatomical and functional change caused by chronic MA abuse by SPECT-CT,PET-CT,MRI,fMRI and proton MRS.These modern neuroimaging techniques allow us to observe change in regional cerebral blood flow and glucose metabolism caused by the abuse and dependence of MA under physiological conditions,to investigate the involvement brain regions and nucleus and to detect some certain neurochemicals change by proton MRS.The combination of neuroimaging techniques allow us monitor the brain anatomical structure change and molecular level change,and many of these neural abnormalities were found to be linked with certain addiction-related phenotypes,such as cognitive inflexibility,maladaptive decision-making and poor self-control.Those addiction-related phenotypes may influence treatment response.Those brain anatomical and functional change may represent novel therapeutic targets,and it will play an important role in clinicians' treatment decisions.The development of the advanced neuroimaging technology will provide agood opportunity for studing and further clarifing the mechanism of MA dependence.
Amphetamines(mainly MA and amphetamine)are the second most prevalent psychoactive substances.In recent years,the abuse and dependence of MA has also became increasingly serious in China.The abuse and dependence of MA has became a global public health problem,which not only has a serious social impact but also occupies a significant amount of medical resources.Despite treating MA out of order,the mortality and relapse rate remains very high.Chronic abuse of MA can cause change in regional cerebral blood flow,glucose metabolism,certain biochemical substances,and even local brain structures.This paper presents a brief overview of the imaging findingsof brain anatomical and functional change caused by the abuse and dependence of MA,which will help us understand the mechanism of MA dependence better.By searching a large number of the latest literatures,the paper summarizes the brain anatomical and functional change caused by chronic MA abuse by SPECT-CT,PET-CT,MRI,fMRI and proton MRS.These modern neuroimaging techniques allow us to observe change in regional cerebral blood flow and glucose metabolism caused by the abuse and dependence of MA under physiological conditions,to investigate the involvement brain regions and nucleus and to detect some certain neurochemicals change by proton MRS.The combination of neuroimaging techniques allow us monitor the brain anatomical structure change and molecular level change,and many of these neural abnormalities were found to be linked with certain addiction-related phenotypes,such as cognitive inflexibility,maladaptive decision-making and poor self-control.Those addiction-related phenotypes may influence treatment response.Those brain anatomical and functional change may represent novel therapeutic targets,and it will play an important role in clinicians' treatment decisions.The development of the advanced neuroimaging technology will provide agood opportunity for studing and further clarifing the mechanism of MA dependence.
引文
[1]United Nations Office on Drugs and Crime.World Drug Report[R].New York:United Nations Office on Drugs and Crime,2017.
[2]王同瑜,鲍彦平.甲基苯丙胺滥用与认知功能损害的研究进展[J].中国生化药物杂志,2017,37(1):306-310.Wang Tongyu,Bao Yanping.Effects of chronic mefhamphetamine use on cognitive impairment in human[J].Chinese Journal of Biochemical Pharmaceutics,2017,37(1):306-310(in Chinese).
[3]Suckling J,Nestor L J.The neurobiology of addiction:the perspective from magnetic resonance imaging present and future[J].Addiction,2017,112(2):360-369.
[4]Hwang J,Lyoo I K,Kim S J,et al.Decreased cerebral blood flow of the right anterior cingulate cortex in long-term and short-term abstinent methamphetamine users[J].Drug Alcohol Depend,2006,82(2):177-181.
[5]Devous M D,Trivedi M H,Rush A J.Regional cerebral blood flow response to oral amphetamine challenge in healthy volunteers[J].J Nucl Med,2001,42(4):535-542.
[6]贾少微.精神活性物质依赖[M].北京:人民卫生出版社,2013:293-478.
[7]Zheng X,Wei W,Huang Q,et al.A computeraided analysis method of SPECT brain images for quantitative treatment monitoring:performance evaluations and clinical applications[J].Biomed Res Int,2017,175(5):1-11.
[8]London E D,Kohno K,Morales A,et al.Chronic methamphetamine abuse and corticostriatal deficits revealed by neuroimaging[J].Brain Res,2015,1628(Pt A):174-185.
[9]London E D,Simon S L,Berman S M,et al.Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine abusers[J].Arch Gen Psychiatry,2004,61(1):73-84.
[10]Volkow N D,Chang L,Wang G J,et al.Higher cortical and lower subcortical metabolism in detoxified methamphetamine abusers[J].Am J Psychiatry,2001,158(3):383-389.
[11]Berman S M,Voytek B,Mandelkern M A,et al.Changes in cerebral glucose metabolism during early abstinence from chronic methamphetamine abuse[J].Mol Psychiatry,2008,13(9):897-908.
[12]Wang G J,Volkow N D,Chang L,et al.Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence[J].Am J Psychiatry,2004,161(2):242-248.
[13]Bodea S.CNS metabolism in high-risk drug abuse:Insights gained from 1H-,31P-MRS and PET[J].Radiologe,2017,57(6):443-449.
[14]Suckling J,Nestor L J.The neurobiology of addiction:the perspective from magnetic resonance imaging presentand future[J].Addiction,2017,112(2):360-369.
[15]Jan R K,Kydd R R,Russell B R.Functional and structural brain changes associated with methamphetamine abuse[J].Brain Sci,2012,2(4):434-482.
[16]Bartzokis G,Beckson M,Edwards N,et al.Age-related brain volume reductions in amphetamine and cocaine addicts and normal controls:implications for addiction research[J].Psychiatry Research:Neuroimaging,2000,98:93-102.
[17]Nakama H,Chang L,Fein G,et al.Methamphetamine users show greater than normal agerelated cortical gray matter loss[J].Ernst T Addiction,2011,106(8):1 474-1 483.
[18]Thompson P M,Hayashi K M,Simon S L,et al.Structural abnormalities in the brains of human subjects who use methamphetamine[J].J Neurosci,2004,24(26):6 028-6 036.
[19]Bartzokis G,Beckson M,Lu P H,et al.Age-related brain volume reductions in amphetamine and cocaine addicts and normal controls:implications for addiction research[J].Psychiatry Res,2000,98(2):93-102.
[20]Thompson P M,Hayashi K M,Simon S L,et al.Structural abnormalities in the brains of human subjects who use methamphetamine[J].J Neurosci,2004,24(26):6 028-6 036.
[21]Berman S,O'Neill J,Fears S,et al.Abuse of amphetamines and structural abnormalities in the brain[J].Ann N Y Acad Sci,2008,1 141(5):195-220.
[22]Churchwell J C,Carey P D,Ferrett H L,et al.Abnormal striatal circuitry and intensified novelty seeking among adolescents who abuse methamphetamine and cannabis[J].Developmental Neuroscience,2012,34(4):310-317.
[23]Jan R K,Lin J C,Miles S W,et al.Striatal volume increases in active methamphetaminedependent individuals and correlation with cognitive performance[J].Brain sciences,2012,2(4):553-572.
[24]Groman S M,Morales A M,Lee B,et al.Methamphetamine-induced increases in putamen gray matter associate with inhibitory control[J].Psychopharmacology,2013,229(3):527-538.
[25]Chang L,Cloak C,Patterson K,et al.Enlarged striatum in abstinent methamphetamine abusers:apossible compensatory response[J].Biol Psychiatry,2005,57(9):967-974.
[26]Jernigan T,Gamst A,Archibald S,et al.Effects of methamphetamine dependence and HIV infection on cerebral morphology[J].American Journal of Psychiatry,2005,162:1 461-1 472.
[27]Chang L,Alicata D,Ernst T,et al.Structural and metabolic brain changes in the striatum associated with methamphetamine abuse[J].Addiction,2007,102(Supp1):16-32.
[28]Ruan X,Zhong N,Yang Z,et al.Gray matter volume showed dynamic alterations in methamphetamine users at 6and 12months abstinence:A longitudinal voxel-based morphometry study[J].Prog Neuropsychopharmacol Biol Psychiatry,2018,81(2):350-355.
[29]Chang L,Smith L M,LoPresti C,et al.Smaller subcortical volumes and cognitive deficits in children with prenatal methamphetamine exposure[J].Psychiatry Res,2004,132(2):95-106.
[30]Oh J S,Lyoo I K,Sung Y H,et al.Shape changes of the corpus callosum in abstinent methamphetamine users[J].Neurosci Lett,2005,384(1-2):76-81.
[31]Morales A M,Lee B,Hellemann G,et al.Graymatter volume in methamphetamine dependence:cigarette smoking and changes with abstinence from methamphetamine[J].Drug Alcohol Depend,2012,125(3):230-238.
[32]Kim S J,Lyoo I K,Hwang J,et al.Prefrontal grey-matter changes in short-term and long-term abstinent methamphetamine abusers[J].Int J Neuropsychopharmacol,2006,9(2):221-228.
[33]Nestor L J,Ghahremani D G,Monterosso J,et al.Prefrontal hypoactivation during cognitive control in early abstinent methamphetaminedependent subjects[J].Psychiatry Res,2011,194(3):287-295.
[34]Salo R,Ursu S,Buonocore M H,et al.Impaired prefrontal cortical function and disrupted adaptive cognitive control in methamphetamine abusers:a functional magnetic resonance imaging study[J].Biol Psychiatry,2009,65(8):706-709.
[35]Bischoff-Grethe A,Connolly C G,Jordan S J,et al.Altered reward expectancy in individuals with recent methamphetamine dependence[J].J Psychopharmacol,2017,31(1):17-30.
[36]Smith D G,Jones P S,Bullmore E T,et al.Cognitive control dysfunction and abnormal frontal cortex activation in stimulant drug users and their biological siblings[J].Transl Psychiatry,2013,3:e257-e257.
[37]Hellem T,Shi X,Latendresse G,et al.The utility of magnetic resonance spectroscopy for understanding substance use disorders:a systematic review of the literature[J].J Am Psychiatr Nurses Assoc,2015,21:244-275.
[38]Achtnichts L,Gonen O,Rigotti D J,et al.Global N-acetylaspartate concentration in benign and non-benign multiple sclerosis patients of long disease duration[J].Eur J Radiol,2013,82(12):e848-e852.
[39]Verma G,Woo J H,Chawla S,et al.Wholebrain analysis of amyotrophic lateral sclerosis by using echo-planar spectroscopic imaging[J].Radiology,2013,267(3):851-857.
[40]Maltezos S,Horder J,Coghlan S,et al.Glutamate/glutamine and neuronal integrity in adults with ADHD:aproton MRS study[J].Transl Psychiatry,2014,18;4(5):e373.
[41]Salo R,Nordahl T E,Natsuaki Y,et al.Attentional control and brain metabolite levels in methamphetamine abusers[J].Biol Psychiatry,2007,61(11):1 272-1 280.
[42]Ernst T,Chang L.Adaptation of brain glutamate plus glutamine during abstinence from chronic methamphetamine use[J].J Neuroimmune Pharmacol,2008,3(3):165-172.
[43]Lin J C,Jan R K,Kydd R R,et al.Investigating the microstructural and neurochemical environment within the basal ganglia of current methamphetamine abusers[J].Drug Alcohol Depend,2015,149(2):122-127.
[44]Salo R,Buonocore M H,Leamon M,et al.Extended findings of brain metabolite normalization in MA-dependent subjects across sustained abstinence:aproton MRS study[J].Drug Alcohol Depend,2011,113(2-3):133-138.
[45]Howells F M,Uhlmann A,Temmingh H,et al.(1)H-magnetic resonance spectroscopy((1)HMRS)in methamphetamine dependence and methamphetamine induced psychosis[J].Schizophr Res,2014,153(1-3):122-128.
[46]Salo R,Nordahl T E,Buonocore M H,et al.Spatial inhibition and the visual cortex:a magnetic resonance spectroscopy imaging study[J].Neuropsychologia,2011,49(5):830-838.
[2]王同瑜,鲍彦平.甲基苯丙胺滥用与认知功能损害的研究进展[J].中国生化药物杂志,2017,37(1):306-310.Wang Tongyu,Bao Yanping.Effects of chronic mefhamphetamine use on cognitive impairment in human[J].Chinese Journal of Biochemical Pharmaceutics,2017,37(1):306-310(in Chinese).
[3]Suckling J,Nestor L J.The neurobiology of addiction:the perspective from magnetic resonance imaging present and future[J].Addiction,2017,112(2):360-369.
[4]Hwang J,Lyoo I K,Kim S J,et al.Decreased cerebral blood flow of the right anterior cingulate cortex in long-term and short-term abstinent methamphetamine users[J].Drug Alcohol Depend,2006,82(2):177-181.
[5]Devous M D,Trivedi M H,Rush A J.Regional cerebral blood flow response to oral amphetamine challenge in healthy volunteers[J].J Nucl Med,2001,42(4):535-542.
[6]贾少微.精神活性物质依赖[M].北京:人民卫生出版社,2013:293-478.
[7]Zheng X,Wei W,Huang Q,et al.A computeraided analysis method of SPECT brain images for quantitative treatment monitoring:performance evaluations and clinical applications[J].Biomed Res Int,2017,175(5):1-11.
[8]London E D,Kohno K,Morales A,et al.Chronic methamphetamine abuse and corticostriatal deficits revealed by neuroimaging[J].Brain Res,2015,1628(Pt A):174-185.
[9]London E D,Simon S L,Berman S M,et al.Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine abusers[J].Arch Gen Psychiatry,2004,61(1):73-84.
[10]Volkow N D,Chang L,Wang G J,et al.Higher cortical and lower subcortical metabolism in detoxified methamphetamine abusers[J].Am J Psychiatry,2001,158(3):383-389.
[11]Berman S M,Voytek B,Mandelkern M A,et al.Changes in cerebral glucose metabolism during early abstinence from chronic methamphetamine abuse[J].Mol Psychiatry,2008,13(9):897-908.
[12]Wang G J,Volkow N D,Chang L,et al.Partial recovery of brain metabolism in methamphetamine abusers after protracted abstinence[J].Am J Psychiatry,2004,161(2):242-248.
[13]Bodea S.CNS metabolism in high-risk drug abuse:Insights gained from 1H-,31P-MRS and PET[J].Radiologe,2017,57(6):443-449.
[14]Suckling J,Nestor L J.The neurobiology of addiction:the perspective from magnetic resonance imaging presentand future[J].Addiction,2017,112(2):360-369.
[15]Jan R K,Kydd R R,Russell B R.Functional and structural brain changes associated with methamphetamine abuse[J].Brain Sci,2012,2(4):434-482.
[16]Bartzokis G,Beckson M,Edwards N,et al.Age-related brain volume reductions in amphetamine and cocaine addicts and normal controls:implications for addiction research[J].Psychiatry Research:Neuroimaging,2000,98:93-102.
[17]Nakama H,Chang L,Fein G,et al.Methamphetamine users show greater than normal agerelated cortical gray matter loss[J].Ernst T Addiction,2011,106(8):1 474-1 483.
[18]Thompson P M,Hayashi K M,Simon S L,et al.Structural abnormalities in the brains of human subjects who use methamphetamine[J].J Neurosci,2004,24(26):6 028-6 036.
[19]Bartzokis G,Beckson M,Lu P H,et al.Age-related brain volume reductions in amphetamine and cocaine addicts and normal controls:implications for addiction research[J].Psychiatry Res,2000,98(2):93-102.
[20]Thompson P M,Hayashi K M,Simon S L,et al.Structural abnormalities in the brains of human subjects who use methamphetamine[J].J Neurosci,2004,24(26):6 028-6 036.
[21]Berman S,O'Neill J,Fears S,et al.Abuse of amphetamines and structural abnormalities in the brain[J].Ann N Y Acad Sci,2008,1 141(5):195-220.
[22]Churchwell J C,Carey P D,Ferrett H L,et al.Abnormal striatal circuitry and intensified novelty seeking among adolescents who abuse methamphetamine and cannabis[J].Developmental Neuroscience,2012,34(4):310-317.
[23]Jan R K,Lin J C,Miles S W,et al.Striatal volume increases in active methamphetaminedependent individuals and correlation with cognitive performance[J].Brain sciences,2012,2(4):553-572.
[24]Groman S M,Morales A M,Lee B,et al.Methamphetamine-induced increases in putamen gray matter associate with inhibitory control[J].Psychopharmacology,2013,229(3):527-538.
[25]Chang L,Cloak C,Patterson K,et al.Enlarged striatum in abstinent methamphetamine abusers:apossible compensatory response[J].Biol Psychiatry,2005,57(9):967-974.
[26]Jernigan T,Gamst A,Archibald S,et al.Effects of methamphetamine dependence and HIV infection on cerebral morphology[J].American Journal of Psychiatry,2005,162:1 461-1 472.
[27]Chang L,Alicata D,Ernst T,et al.Structural and metabolic brain changes in the striatum associated with methamphetamine abuse[J].Addiction,2007,102(Supp1):16-32.
[28]Ruan X,Zhong N,Yang Z,et al.Gray matter volume showed dynamic alterations in methamphetamine users at 6and 12months abstinence:A longitudinal voxel-based morphometry study[J].Prog Neuropsychopharmacol Biol Psychiatry,2018,81(2):350-355.
[29]Chang L,Smith L M,LoPresti C,et al.Smaller subcortical volumes and cognitive deficits in children with prenatal methamphetamine exposure[J].Psychiatry Res,2004,132(2):95-106.
[30]Oh J S,Lyoo I K,Sung Y H,et al.Shape changes of the corpus callosum in abstinent methamphetamine users[J].Neurosci Lett,2005,384(1-2):76-81.
[31]Morales A M,Lee B,Hellemann G,et al.Graymatter volume in methamphetamine dependence:cigarette smoking and changes with abstinence from methamphetamine[J].Drug Alcohol Depend,2012,125(3):230-238.
[32]Kim S J,Lyoo I K,Hwang J,et al.Prefrontal grey-matter changes in short-term and long-term abstinent methamphetamine abusers[J].Int J Neuropsychopharmacol,2006,9(2):221-228.
[33]Nestor L J,Ghahremani D G,Monterosso J,et al.Prefrontal hypoactivation during cognitive control in early abstinent methamphetaminedependent subjects[J].Psychiatry Res,2011,194(3):287-295.
[34]Salo R,Ursu S,Buonocore M H,et al.Impaired prefrontal cortical function and disrupted adaptive cognitive control in methamphetamine abusers:a functional magnetic resonance imaging study[J].Biol Psychiatry,2009,65(8):706-709.
[35]Bischoff-Grethe A,Connolly C G,Jordan S J,et al.Altered reward expectancy in individuals with recent methamphetamine dependence[J].J Psychopharmacol,2017,31(1):17-30.
[36]Smith D G,Jones P S,Bullmore E T,et al.Cognitive control dysfunction and abnormal frontal cortex activation in stimulant drug users and their biological siblings[J].Transl Psychiatry,2013,3:e257-e257.
[37]Hellem T,Shi X,Latendresse G,et al.The utility of magnetic resonance spectroscopy for understanding substance use disorders:a systematic review of the literature[J].J Am Psychiatr Nurses Assoc,2015,21:244-275.
[38]Achtnichts L,Gonen O,Rigotti D J,et al.Global N-acetylaspartate concentration in benign and non-benign multiple sclerosis patients of long disease duration[J].Eur J Radiol,2013,82(12):e848-e852.
[39]Verma G,Woo J H,Chawla S,et al.Wholebrain analysis of amyotrophic lateral sclerosis by using echo-planar spectroscopic imaging[J].Radiology,2013,267(3):851-857.
[40]Maltezos S,Horder J,Coghlan S,et al.Glutamate/glutamine and neuronal integrity in adults with ADHD:aproton MRS study[J].Transl Psychiatry,2014,18;4(5):e373.
[41]Salo R,Nordahl T E,Natsuaki Y,et al.Attentional control and brain metabolite levels in methamphetamine abusers[J].Biol Psychiatry,2007,61(11):1 272-1 280.
[42]Ernst T,Chang L.Adaptation of brain glutamate plus glutamine during abstinence from chronic methamphetamine use[J].J Neuroimmune Pharmacol,2008,3(3):165-172.
[43]Lin J C,Jan R K,Kydd R R,et al.Investigating the microstructural and neurochemical environment within the basal ganglia of current methamphetamine abusers[J].Drug Alcohol Depend,2015,149(2):122-127.
[44]Salo R,Buonocore M H,Leamon M,et al.Extended findings of brain metabolite normalization in MA-dependent subjects across sustained abstinence:aproton MRS study[J].Drug Alcohol Depend,2011,113(2-3):133-138.
[45]Howells F M,Uhlmann A,Temmingh H,et al.(1)H-magnetic resonance spectroscopy((1)HMRS)in methamphetamine dependence and methamphetamine induced psychosis[J].Schizophr Res,2014,153(1-3):122-128.
[46]Salo R,Nordahl T E,Buonocore M H,et al.Spatial inhibition and the visual cortex:a magnetic resonance spectroscopy imaging study[J].Neuropsychologia,2011,49(5):830-838.