阿片类处方镇痛药可迅速改变人类大脑结构.doc

阿片类处方镇痛药可迅速改变人类大脑结构生国疼痛医学杂志ChineseJournalofPainMedicine2011,17,f116JonesJP.OstonecrosisM,McCartyDJ,KoopmnnWJ.Arthritisandalliedconditions:atextbookofrheumatology12thed.Phliadelphia:PaLea&Febiger,1993:16771695.7储玉山,曹建民,孔伟东,等.非创伤性股骨头缺血性坏死骨髓水肿的数字减影血管造影研究.医学研究生,2006,19:712715.8ShuaiB,ShenL,YangYeta1.Lowplasmaadiponectinasapotentialbiomarkerforosteonecrosisofthefemoralhead.TheJournalofrheumatology.0ct:37:21512155.9HirataT,FujiokaM,TakahashiKA,eta1.LowmolecularweightphenotypeofApo(a)isariskofcOrticosteroid.inducedosteonecrOsisofthefemoralheadafterrenaltransplant.JRheumatol,2007,34:5l6522.10HirataT,FujiokaM,TakahashiKA,eta1.ApoBC7623Tpolymorphismpredictsriskforsteroidinducedosteonecrosisofthefemoralheadafterrenaltransplantation.JOrthopSci,2007,12:199206.11ShinodaY,YamaguchiM,OgataN,eta1.Regulationofboneformationbyadiponectinthroughautocrine/paracrineandendocrinepathways.Journalofcellularbiochemistry.2006Sep1:99:196208.12LindenlaubLSommerC.Cytokinesinsuralner-vebiopsiesfrominflammatoryandnon.inflamm.?647?atoryneuropathies.Actaneuropathologica.2003Jun;105:593602.13TakPp,SmeetsTJ,DahaMR,eta1.Analysisofthesynovialcellinfiltrateinearlyrheumatoidsy-novialtissueinrelationtolocaldiseaseactivity.Arthritisandrheumatism.1997Feb;40:21725.14SommerC,SchmidtC,GeorgeA.HyperalgesiainexperimentalneuropathyisdependentontheTNFreceptor1.Experimentalneurology.1998May;151:138142.15WagnerR,MyersRR,OBrienJS.ProsaptidepreventshyperalgesiaandreducesperipheralTNFR1expressionfollowingTNFalphanerveinjection.Neuroreport.1998Aug24;9:28272831.16JungerH,SorkinLS.NociceptiveandinflammatoryeffectsofsubcutaneousTNFalpha.Pain.2000Mar;85:145151.17WagnerR,MyersRR.Schwanncellsproducetumornecrosisfactoralpha:expressionininjuredandnoninjurednerves.Neuroscience.1996Aug;73:625629.18SommerC,SchafersM.PainfulmononeuropathyinC57BL/Wldmicewithdelayedwalleriandegeneration:differentiaIeffectsofcytokineproductionandnerveregenerationonthermalandmechanicalhypersensitivityBrainresearch.1998Feb16:784:154162.阿片类处方镇痛药可迅速改变人类大脑结构以往研究证实,长期使用阿片类药物能够使动物产生神经可塑性变化,然而,短期内使用镇痛剂量的阿片类药物能否改变人类大脑结构,目前尚不清楚.最近,斯坦福大学的YoungerJw教授及其团队对此进行了研究.10名患有慢性腰背痛(chroniclowbackpain)的被试每天口服吗啡,持续时间为一个月.在服用吗啡前后通过磁共振成像技术获取其大脑的高分辨率解剖像,并将灰质体积的局部改变与吗啡用量进行相关分析.结果表明,13个脑区有明显的体积改变,并且一些脑区的改变程度和吗啡剂量相关.剂量相关性的体积减少主要发生在右侧杏仁核,剂量相关性的体积增加发生在右下丘脑,左额下回,右腹后扣带回以及右脑桥尾侧.平均4.7个月之后的随访发现,脑区的这些改变依然存在.在另外一项独立研究中,9名连续6周服用安慰剂胶囊的被试没有明显的形态学改变.由于杏仁核与奖赏学习过程相关,此研究结果证实服用阿片类药物能引起奖赏加工脑回路结构与功能的改变,并且这些改变是持久和稳定的.该