Wollman Scott C, Alhassoon Omar M, Hall Matthew G, Stern Mark J, Connors Eric J, Kimmel Christine L, Allen Kenneth E, Stephan Rick A, Radua Joaquim
a California School of Professional Psychology , San Diego , CA , USA.
b Department of Psychiatry , University of California , San Diego , CA , USA.
Am J Drug Alcohol Abuse. 2017 Sep;43(5):505-517. doi: 10.1080/00952990.2016.1245312. Epub 2016 Nov 3.
Prior research utilizing whole-brain neuroimaging techniques has identified structural differences in gray matter in opioid-dependent individuals. However, the results have been inconsistent.
The current study meta-analytically examines the neuroimaging findings of studies published before 2016 comparing opioid-dependent individuals to drug-naïve controls.
Exhaustive search of five databases yielded 12 studies that met inclusion criteria. Anisotropic Effect-Size Seed-Based d Mapping (AES-SDM) was used to analyze the data extracted by three independent researchers. Voxel-based AES-SDM distinguishes increases and decreases in brain matter significant at the whole-brain level.
AES-SDM identified the fronto-temporal region, bilaterally, as being the primary site of gray matter deficits associated with opioid use. Moderator analysis revealed that length of opioid use was negatively associated with gray matter in the left cerebellar vermis and the right Rolandic operculum, including the insula. Meta-regression revealed no remaining significant areas of gray matter reductions, except in the precuneus, following longer abstinence from opioids.
Opioid-dependent individuals had significantly less gray matter in several regions that play a key role in cognitive and affective processing. The findings provide evidence that opioid dependence may result in the breakdown of two distinct yet highly overlapping structural and functional systems. These are the fronto-cerebellar system that might be more responsible for impulsivity, compulsive behaviors, and affective disturbances and the fronto-insular system that might account more for the cognitive and decision-making impairments.
先前利用全脑神经成像技术进行的研究已确定阿片类药物依赖个体的灰质存在结构差异。然而，结果并不一致。
本研究采用荟萃分析方法，考察2016年之前发表的将阿片类药物依赖个体与未使用过药物的对照组进行比较的研究的神经成像结果。
对五个数据库进行详尽检索，得到12项符合纳入标准的研究。使用基于各向异性效应大小种子点的d映射（AES-SDM）对由三名独立研究人员提取的数据进行分析。基于体素的AES-SDM可区分全脑水平上显著的脑物质增加和减少。
AES-SDM确定双侧额颞区域是与阿片类药物使用相关的灰质缺陷的主要部位。调节因素分析显示，阿片类药物使用时间与左侧小脑蚓部和右侧中央 operculum（包括脑岛）的灰质呈负相关。荟萃回归显示，除了楔前叶外，在更长时间戒除阿片类药物后，没有其他剩余的显著灰质减少区域。
阿片类药物依赖个体在几个对认知和情感处理起关键作用的区域的灰质显著减少。这些发现提供了证据，表明阿片类药物依赖可能导致两个不同但高度重叠的结构和功能系统的破坏。这两个系统分别是可能对冲动、强迫行为和情感障碍更负责的额小脑系统，以及可能更多地解释认知和决策障碍的额岛系统。
