Nasrun Martina Ws, Ginting Tribowo T, Siste Kristiana, Pandelaki Jacub, Kekalih Aria, Louisa Melva, Susanto Agus D, Utami Diah S, Tarigan Immanuel N, Trishna Alya R, Halim Kelvin
Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Doctoral Program in Medical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Narra J. 2025 Apr;5(1):e2178. doi: 10.52225/narra.v5i1.2178. Epub 2025 Mar 24.
N-acetylcysteine (NAC) is known to enhance neuroplasticity and help reduce smoking addiction by modulating brain metabolites. The use of magnetic resonance spectroscopy (MRS) in smokers receiving NAC as an adjuvant to motivational enhancement therapy (MET) represents a novel approach to understanding how this combination therapy influences brain chemistry. By utilizing MRS, the effectiveness of NAC can be quantitatively assessed by analyzing changes in smoking-affected brain metabolites. The aim of this study was to evaluate the efficacy of NAC combined with MET for nicotine addiction, using MRS to assess neurochemical alterations associated with treatment response. A stratified, randomized, parallel-group clinical trial was conducted, comparing NAC and MET combination to MET only among smokers. The study analyzed the effectiveness of NAC by evaluating glutamate-glutamine (Glx) to creatine ratio (Glx/creatine ratio) and N-acetylaspartate (NAA) to creatine ratio (NAA/creatine ratio) in the nucleus accumbens, bilateral cerebellum, medial prefrontal cortex, ventromedial prefrontal cortex, and bilateral precuneus. Our data indicated that the Glx/creatine ratios for the intervention versus control groups were as follows: nucleus accumbens (0.68 vs 0. 43), bilateral cerebellum (0.68 vs 0.43), left medial prefrontal cortex (1.11 vs 0.82), ventromedial prefrontal cortex (0.32 vs 0.86), and bilateral precuneus (0.75 vs 0.58). The NAA/creatine ratios for the intervention versus control groups were as follows: nucleus accumbens (3.55 vs 8.35), bilateral cerebellum (7.82 vs 4.02), left medial prefrontal cortex (5.47 vs 5.20), ventromedial prefrontal cortex (3.55 vs 7.46), and bilateral precuneus (4.73 vs 4.00). Our analysis indicated that the Glx/creatine ratio was higher in the intervention group than in the control group in the medial prefrontal cortex ( = 0.02), while the NAA/creatine ratio was higher in the intervention group than in the control group in the bilateral cerebellum ( < 0.001). The reported side effects were mild to moderate discomfort and well-tolerated across both groups. These findings highlight the potential of NAC and MET combination in promoting neuroplasticity and supporting nicotine addiction treatment.
已知N-乙酰半胱氨酸（NAC）可增强神经可塑性，并通过调节脑代谢物来帮助减少吸烟成瘾。在接受NAC作为动机增强疗法（MET）辅助治疗的吸烟者中使用磁共振波谱（MRS），是一种了解这种联合疗法如何影响脑化学的新方法。通过利用MRS，可以通过分析受吸烟影响的脑代谢物的变化来定量评估NAC的有效性。本研究的目的是评估NAC联合MET治疗尼古丁成瘾的疗效，使用MRS评估与治疗反应相关的神经化学改变。进行了一项分层、随机、平行组临床试验，在吸烟者中比较NAC与MET联合治疗和单纯MET治疗。该研究通过评估伏隔核、双侧小脑、内侧前额叶皮质、腹内侧前额叶皮质和双侧楔前叶中谷氨酸-谷氨酰胺（Glx）与肌酸的比率（Glx/肌酸比率）以及N-乙酰天门冬氨酸（NAA）与肌酸的比率（NAA/肌酸比率）来分析NAC的有效性。我们的数据表明，干预组与对照组的Glx/肌酸比率如下：伏隔核（0.68对0.43）、双侧小脑（0.68对0.43）、左侧内侧前额叶皮质（1.11对0.82）、腹内侧前额叶皮质（0.32对0.86）和双侧楔前叶（0.75对0.58）。干预组与对照组的NAA/肌酸比率如下：伏隔核（3.55对8.35）、双侧小脑（7.82对4.02）、左侧内侧前额叶皮质（5.47对5.20）、腹内侧前额叶皮质（3.55对7.46）和双侧楔前叶（4.73对4.00）。我们的分析表明，在内侧前额叶皮质中，干预组的Glx/肌酸比率高于对照组（=0.02），而在双侧小脑中，干预组的NAA/肌酸比率高于对照组（<0.001）。报告的副作用为轻度至中度不适，两组均耐受性良好。这些发现突出了NAC与MET联合治疗在促进神经可塑性和支持尼古丁成瘾治疗方面的潜力。
