中文摘要：

目的：探讨美沙酮维持治疗（MMT）对海洛因成瘾者伏隔核功能连接的作用,明确 MMT 对成瘾者渴求影响的潜在神经机制。方法37例 MMT 海洛因成瘾者（MMT 组）和25例人口学特征、海洛因使用情况相匹配的单纯海洛因成瘾者（HA 组）进行药物渴求程度评分和 fMRI 扫描。采用基于 Matlab 2009a 平台的静息态 fMRI 数据处理助手（DPARSF）软件进行数据预处理。采用静息态 fMRI 数据分析工具包（REST）,以双侧伏隔核（Nacc）为 ROI,与全脑其他所有体素的时间序列作相关分析,单样本 t 检验和两样本 t 检验分别用于组内和组间分析。使用 SPSS 软件,将组间差异区内 MMT 组功能连接强度值与美沙酮使用时间及剂量作偏相关分析,渴求程度评分比较采用两样本 t 检验。结果与 HA 组相比,MMT 组右侧伏隔核与左背内、外侧前额叶、右背侧前扣带功能连接增强,与右内侧眶额回功能连接减弱；左侧伏隔核与左背内、外侧前额叶、右背外侧前额叶、右背侧前扣带、左侧岛叶功能连接增强,未发现功能连接减低的脑区（单个体素 P〈0.005,体素值〉26,t=2.91）；MMT 组主观渴求评分显著小于 HA 组（t=-2.03,P〈0.05）。MMT 组存在显著差异脑区的功能连接强度值与美沙酮使用时间及剂量无明显相关性（P〈0.05）。结论MMT 可能通过认知控制环路与动机驱动环路的共同作用来影响奖赏环路伏隔核的功能,从而降低海洛因成瘾者的毒品渴求。

英文摘要：

Objective To explore the effect of methadone maintenace treatment （MMT）in functional connectivity （FC）of nucleus accumbens （Nacc）on heroin addicts,and to identify the potential neuromechanism of MMT performing on heroin craving.Methods Craving scores and resting-state fMRI （rs-fMRI）were performed in 37 heroin addicts under MMT and 26 matched heroin addicts （HA） without any treatment.The rs-fMRI data preprocessing was performed by data processing assistant for rs-fMRI （DPARSF）soft-ware based on Matlab 2009a.Bilateral Naccs were set as regions of interesting （ROIs）respectively,and then the mean time series and other voxels within whole brain were analyzed by the rs-fMRI data analysis toolkit （REST）.Intra-and inter-group analysis was performed with a single sample t-test and two sample t-test respectively.The partial correlation between the intensity of FC in brain regions showed abnormal FC and the duration/doses of methadone consumption was further investigated by SPSS.Craving scores were tested with two sample t-test.Results Inter-group analysis showed the FC of the right Nacc with left dorsal medial/lateral prefrontal cortex and right dorsal anterior cingulate was significantly increased in the MMT group in comparisonwith HA group,how-ever,it was decreased with right medial orbitofrontal cortex.The FC between the left Nacc and left dorsal medial/lateral prefrontal cortex,right dorsal lateral prefrontal cortex,right dorsal anterior cingulate and left insular cortex was also significantly increased in the MMT group （P〈0.005,voxels〉26,t=2.91）.There were no regions with induced FC.The craving scores of MMT were signifi-cantly lower than those of HA （t = - 2.03,P〈0.05 ）.There was no significant correlation between the abnormal FC and the＆amp;nbsp;duration/doses of methadone consumption in MMT group.Conclusion MMT may influence the function of the nucleus accumbens through cognitive control and motivation/drive circuits,thereby reduce drug craving of heroin addicts.