Kivisaari Reetta, Rapeli Pekka, Van Leemput Koen, Kähkönen Seppo, Puuskari Varpu, Jokela Olga, Autti Taina
Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
J Opioid Manag. 2010 Nov-Dec;6(6):423-9. doi: 10.5055/jom.2010.0040.
Opioid-dependent patients have been shown to have structural brain alterations. This study focuses on magnetic resonance imaging (MRI) measurements of brain and their correlation with the onset age and the duration of opioid abuse.
Brain MRI was obtained from 17 opioid-dependent patients (mean age 34 years, SD 7 years) and 17 controls. Compulsive opioid use had begun between ages 15 and 31 (mean 20) and had continued from 5 to 26 years. All patients were tobacco smokers, six had also abused amphetamines and 11 benzodiazepines. Relative volumes of cerebral white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF) spaces were measured. In addition, Sylvian fissure ratio (SFR), bifrontal ratio, and midsagittal cerebellar vermian area were correlated with the onset age and the duration of opioid abuse.
The total volume (GM + WM + CSF) of the cerebrum was significantly smaller in patients than in controls (Mann-Whitney U-test, p = 0.026) as well as the absolute volumes of GM and WM (p = 0.014 and p = 0.007, respectively). There was no significant difference in GM and WM volumes normalized with total cerebral volume. In contrast, the absolute volume of CSF did not significantly differ between the groups, but the relative volume of CSF was significantly higher in opioid dependents (p = 0.029). SFR and bifrontal ratio were larger in opioid dependents than in controls (p = 0.005 and p = 0.013). The SFR correlated negatively (p = 0.017, r = - 0.569) and the area of vermis cerebelli correlated positively (p = 0.043, r = 0.496) with the onset age of opioid abuse. The length of opioid abuse and the area of vermis cerebellum had a negative correlation (p = 0.038, r = - 0.523) even though the areas of cerebellar vermis did not significantly differ between opioid dependents and controls. The authors speculate that the onset of substance abuse in adolescence or early adulthood may have in part disturbed the late brain maturation process, as in normal development, the dorsolateral frontal cortex and superior parts of the temporal lobes are the last to maturate. Also, the cerebellar vermis may be affected by early onset substance abuse. It is possible that the brain is more vulnerable to substance abuse at a young age than later in life.
阿片类药物依赖患者已被证明存在大脑结构改变。本研究聚焦于大脑的磁共振成像（MRI）测量及其与阿片类药物滥用起始年龄和持续时间的相关性。
对17名阿片类药物依赖患者（平均年龄34岁，标准差7岁）和17名对照者进行了脑部MRI检查。强迫性阿片类药物使用始于15至31岁（平均20岁），持续了5至26年。所有患者均为吸烟者，6人还滥用过苯丙胺，11人滥用过苯二氮䓬类药物。测量了脑白质（WM）、灰质（GM）和脑脊液（CSF）间隙的相对体积。此外，还将外侧裂比率（SFR）、双额叶比率和小脑蚓部矢状中面积与阿片类药物滥用的起始年龄和持续时间进行了相关性分析。
患者大脑的总体积（GM + WM + CSF）显著小于对照组（曼-惠特尼U检验，p = 0.026），GM和WM的绝对体积也显著小于对照组（分别为p = 0.014和p = 0.007）。用大脑总体积标准化后的GM和WM体积无显著差异。相比之下，两组间CSF的绝对体积无显著差异，但阿片类药物依赖者CSF的相对体积显著更高（p = 0.029）。阿片类药物依赖者的SFR和双额叶比率大于对照组（p = 0.005和p = 0.013）。SFR与阿片类药物滥用的起始年龄呈负相关（p = 0.017，r = - 0.569），小脑蚓部面积与起始年龄呈正相关（p = 0.043，r = 0.496）。阿片类药物滥用的时长与小脑蚓部面积呈负相关（p = 0.038，r = - 0.523），尽管阿片类药物依赖者和对照组之间小脑蚓部的面积无显著差异。作者推测，青少年期或成年早期开始物质滥用可能在一定程度上扰乱了大脑后期的成熟过程，因为在正常发育中，背外侧前额叶皮质和颞叶上部是最后成熟的。此外，小脑蚓部可能会受到早期开始的物质滥用的影响。大脑在年轻时可能比在生命后期更容易受到物质滥用的影响。
