探寻 ADHD 共病物质使用障碍的自我药物治疗理论的神经生物学基础：使用 (99m)Tc-TRODAT-1 SPECT 进行多巴胺转运体的体内研究。

Searching for a neurobiological basis for self-medication theory in ADHD comorbid with substance use disorders: an in vivo study of dopamine transporters using (99m)Tc-TRODAT-1 SPECT.

机构信息

From the *Laboratório de Medicina Nuclear do Complexo Hospitalar Santa Casa (LAMENU), Porto Alegre; †ADHD Outpatient Program, Child and Adolescent Psychiatric Division (PRODAH), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre; ‡Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo; §Center for Drug and Alcohol Research, HCPA, Universidade Federal do RGS (UFRGS), Porto Alegre; ¶Universidade Luterana do Brasil, Porto Alegre; and ∥Instituto Nacional de Psiquiatria do Desenvolvimento, Porto Alegre, Brazil.

出版信息

Clin Nucl Med. 2014 Feb;39(2):e129-34. doi: 10.1097/RLU.0b013e31829f9119.

DOI:10.1097/RLU.0b013e31829f9119

PMID:23856832

Abstract

PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD) frequently co-occur. Although several studies have shown changes in striatal dopamine transporter (DAT) density in these disorders, little is known about the neurobiological basis of the comorbidity. The aim of this study was to evaluate striatal DAT density in treatment-naive ADHD adolescents with SUD (ADHD + SUD) and without SUD (ADHD), compared to SUD adolescents without ADHD (SUD) and healthy control subjects (HC).

PATIENTS AND METHODS

Sixty-two male age-matched subjects diagnosed with DSM-IV criteria were included: ADHD + SUD (n = 18), SUD (n = 14), HC (n = 19), and ADHD (n = 11). Urine tests confirmed participants' drug use. All subjects performed SPECT scans with Tc-TRODAT-1 to evaluate DAT density in the striatum.

RESULTS

The mean right striatum specific binding were 1.68 (ADHD), 1.38 (ADHD + SUD), 1.19 (HC), 1.17 (SUD), and in left striatum 1.65 (ADHD), 1.39 (ADHD + SUD), 1.19 (HC), and 1.17 (SUD). The ADHD group presented significantly higher striatal DAT density compared with ADHD + SUD, SUD, and HC groups. Adolescents with ADHD + SUD had significantly lower DAT density than those with ADHD, but significantly higher DAT density than those with SUD only and no significant difference from the healthy control group.

CONCLUSION

The ADHD + SUD group had lower striatal DAT density in comparison with ADHD without SUD. It is possible to speculate that the use of cannabis and cocaine is responsible for the lower striatal DAT density in this group which would help in understanding the neurobiological basis for the self-medication theory in ADHD adolescents.

摘要

目的

注意力缺陷多动障碍（ADHD）和物质使用障碍（SUD）经常同时发生。尽管有几项研究表明这些疾病中的纹状体多巴胺转运蛋白（DAT）密度发生了变化，但对于这种共病的神经生物学基础知之甚少。本研究旨在评估有或无 SUD 的治疗初发 ADHD 青少年（ADHD + SUD 和 ADHD）与 SUD 青少年（SUD）和健康对照组（HC）之间纹状体 DAT 密度。

方法

纳入了 62 名年龄匹配的男性患者，根据 DSM-IV 标准诊断为：ADHD + SUD（n = 18）、SUD（n = 14）、HC（n = 19）和 ADHD（n = 11）。尿液检查证实了参与者的药物使用情况。所有受试者均进行 SPECT 扫描，用 Tc-TRODAT-1 评估纹状体中的 DAT 密度。

结果

右侧纹状体的平均特异性结合率分别为：1.68（ADHD）、1.38（ADHD + SUD）、1.19（HC）、1.17（SUD）；左侧纹状体分别为：1.65（ADHD）、1.39（ADHD + SUD）、1.19（HC）和 1.17（SUD）。与 ADHD + SUD、SUD 和 HC 组相比，ADHD 组的纹状体 DAT 密度明显更高。ADHD + SUD 组的青少年 DAT 密度明显低于 ADHD 组，但明显高于仅 SUD 组，与健康对照组无显著差异。