甲基苯丙胺滥用与依赖的相关影像学研究进展

长期滥用甲基苯丙胺（methamphetamine, MA）可引起患者脑内血流灌注、葡萄糖代谢、某些生物化学物质甚至局部脑结构的改变。本文主要对MA滥用与依赖引起的脑结构及功能改变的影像学表现进行综述，以了解MA滥用与依赖者脑结构及功能的改变与其认知和动机功能损害之间的关系。主要总结利用单光子发射计算机断层成像术 计算机断层扫描术（single-photon emission computed tomography computed tomography, SPECT-CT）、正电子发射断层成像术-计算机断层扫描仪（positron emission tomography-computed tomography, PET-CT）、磁共振成像（magnetic resonance imaging, MRI）、功能性磁共振成像（functional magnetic resonance imaging, fMRI）、质子磁共振波谱（proton magnetic resonance spectroscopy, proton MRS）影像技术观察MA滥用与依赖引起的脑解剖结构改变，以及在生理状态下观察脑内血流灌注及葡萄糖代谢的变化，研究参与甲基苯丙胺依赖的脑区、核团，并且MRS能够检测出脑内某些神经化学物质的变化。在临床工作中联合应用影像检查技术，能够监测MA滥用与依赖期间大脑的变化及预测复吸的可能性，对临床医师的治疗决策起重要作用。

Chronic Methamphetamine Abuse and Brain Deficits Revealed by Neuroimaging

Amphetamines (mainly MA and amphetamine) are the second most prevalent psychoactive substances. In recent years, the abuse and dependence of MA has also became increasingly serious in China. The abuse and dependence of MA has became a global public health problem, which not only has a serious social impact but also occupies a significant amount of medical resources. Despite treating MA out of order, the mortality and relapse rate remains very high. Chronic abuse of MA can cause change in regional cerebral blood flow, glucose metabolism, certain biochemical substances, and even local brain structures. This paper presents a brief overview of the imaging findings of brain anatomical and functional change caused by the abuse and dependence of MA, which will help us understand the mechanism of MA dependence better. By searching a large number of the latest literatures, the paper summarizes the brain anatomical and functional change caused by chronic MA abuse by SPECT-CT, PET-CT, MRI, fMRI and proton MRS. These modern neuroimaging techniques allow us to observe change in regional cerebral blood flow and glucose metabolism caused by the abuse and dependence of MA under physiological conditions, to investigate the involvement brain regions and nucleus and to detect some certain neurochemicals change by proton MRS. The combination of neuroimaging techniques allow us monitor the brain anatomical structure change and molecular level change, and many of these neural abnormalities were found to be linked with certain addiction related phenotypes, such as cognitive inflexibility, maladaptive decision-making and poor self-control. Those addiction-related phenotypes may influence treatment response. Those brain anatomical and functional change may represent novel therapeutic targets, and it will play an important role in clinicians' treatment decisions. The development of the advanced neuroimaging technology will provide a good opportunity for studing and further clarifing the mechanism of MA dependence.