男性酒精依赖患者的威斯康星卡片分类测验及脑质子波谱动态研究

目的 通过磁共振质子波谱(1H-MRS)检测酒精依赖患者额叶代谢物质的变化,探讨酒精依赖所致认知障碍的神经生物学基础.方法 分别于戒酒前和戒酒1个月时应用1H-MRS技术,检测10例男性酒精依赖患者(患者组)的额叶氮-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸(Cr)变化,并与10名正常对照者(对照组)进行比较;同时用威斯康星卡片分类测试(WCST)评定受试者的认知功能.结果 (1)戒酒前,患者组双侧前额叶灰质和白质NAA/Cr比值均低于对照组(P＜0.05),戒酒1个月时较戒酒前有好转(P=0.00),但仍低于对照组(P＜0.05);而Cho/Cr戒酒前后的差异元统计学意义(P＞0.05).(2)患者组戒酒前WCST中的完成分类数(0.70±1.06)个]和概念化水平(16.29±10.27)%]低于戒酒1个月时分别为(3.80±2.15)个,(52.32±20.81)%],而错误应答数(83.60±10.80)个]和持续性错误(34.80±16.94)个]高于戒酒1个月时分别为(42.80±21.06)个,(21.70±11.39)个;P＜0.05].(3)患者组戒酒前后右侧灰质NAA/Cr变化与WCST完成分类数的变化相关(r=0.7002,P＜0.05).结论 长期饮酒可导致酒精依赖患者前额叶代谢物浓度改变;其认知功能的损害,可能与酒精对前额叶代谢物浓度的影响有关.

The changes in proton magnetic resonance spectroscopy and Wisconsin Card Sorting Test before and after alcohol withdrawal in male alcoholics

Objective To explore the cognitive dysfunction and the related neurobiological basis in alcohol dependence.Methods The patients with alcohol dependence and 10 healthy persons were involved.The proton magnetic resonance spectroscopy were used to determine absolute concentrations of N-acetylaspartate(NAA),creatine(Cr),and Choline(Cho)in white and gray matter of the frontal lobe,and cognitive function Was measured with the Wisconsin card sorting test. The patients were examined twice,I.e..when they kept drinking and after 1 month withdrawal.Results The pre-withdrawal NAA/Cr ratio in patient was significanfly lower than that in controls(left white matter:1.45±0.38 vs.2.16±0.40:left gray matter:1.17±0.11 vs.1.67±0.33;right white matter:1.59±0.25 vs.2.09±0.41;right gray matter:1.44±0.40 vs.1.56±0.30;all P＜0.05).After 1 month abstinence,the change of NAA/Cr ratio in right gray matter was significantly correlated to the neuropsychological improvement.Conclusions Alcohol dependence may induce specific metabolic changes in frontal lobe,which may be related to cognitive impairment in patients with alcohol dependence.