Osborne Peter G, Ko Ying-Chin, Wu Ming-Tsang, Lee Chien-Hung
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia; Graduate Institute of Clinical Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Environment-Omics-Diseases Research Centre, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Drug Alcohol Depend. 2017 Oct 1;179:187-197. doi: 10.1016/j.drugalcdep.2017.06.039. Epub 2017 Jul 29.
We present a systematic review of substance use disorder (SUD) to Areca catechu nut (AN) and AN containing betel quid (ANcBQ) with emphasis on dependence resulting from chewing of tobacco-free ANcBQ. We examined pharmacology of intoxication and addiction, and factors influencing quitting strategies.
Epidemiological publications of SUD were included according to PRISMA criteria. Pharmacological publications were retrieved from the PUBMED database and websites of the WHO, United Nations, and Sigma-Aldrich.
Nine epidemiological studies show clear evidence of abuse and dependence in tobacco-free ANcBQ and/or ANcBQ+Tobacco chewers. Dependency is greater if ANcBQ contains tobacco. In both groups higher dependency scores were positively correlated with higher frequency of chewing. Dependency on AN+Lime is associated with altered brain morphology, resting state brain activity, neurochemistry and deterioration of working spatial memory. ANcBQ contains a complex mixture of neuroactive compounds that have the potential to act directly upon all major cerebral neurotransmitter systems. Of these compounds, only arecoline (muscarinic agonist) has been the focus of limited pharmacological investigation. In animal studies, arecoline increases dopamine transmission in the mesocorticolimbic circuit and this action may be one factor contributing to ANcBQ dependency in humans. Societal and familial acceptance of ANcBQ consumption is paramount for commencement and persistence of chewing.
ANcBQ SUD remains an orphan disease. The limited understanding of pharmacological basis of intoxication and SUD determines there are no pharmacological replacement therapies for ANcBQ SUD. The addictive properties of ANcBQ coupled with social acceptance of ANcBQ chewing limits the effectiveness of counseling-based quitting programs.
我们对槟榔及含槟榔的槟榔嚼块所致物质使用障碍（SUD）进行了系统综述，重点关注无烟槟榔嚼块咀嚼所致的依赖。我们研究了中毒和成瘾的药理学，以及影响戒烟策略的因素。
根据PRISMA标准纳入SUD的流行病学出版物。药理学出版物从PUBMED数据库以及世界卫生组织、联合国和西格玛奥德里奇公司的网站上检索。
九项流行病学研究表明，无烟槟榔嚼块和/或无烟槟榔嚼块加烟草咀嚼者存在明显的滥用和依赖证据。如果槟榔嚼块含有烟草，依赖性会更强。在两组中，较高的依赖得分与较高的咀嚼频率呈正相关。对槟榔加石灰的依赖与大脑形态改变、静息态脑活动、神经化学以及工作空间记忆衰退有关。槟榔嚼块含有多种神经活性化合物的复杂混合物，这些化合物有可能直接作用于所有主要的大脑神经递质系统。在这些化合物中，只有槟榔碱（毒蕈碱激动剂）是有限药理学研究的重点。在动物研究中，槟榔碱增加了中脑边缘叶回路中的多巴胺传递，这一作用可能是导致人类对槟榔嚼块产生依赖的因素之一。社会和家庭对食用槟榔嚼块的接受程度对于开始和持续咀嚼至关重要。
槟榔嚼块所致物质使用障碍仍然是一种未被充分研究的疾病。对中毒和物质使用障碍药理学基础的有限了解决定了目前尚无针对槟榔嚼块所致物质使用障碍的药物替代疗法。槟榔嚼块的成瘾特性加上社会对咀嚼槟榔嚼块的接受程度限制了基于咨询的戒烟计划的有效性。
