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    Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/3288


    Title: 美沙冬維持治療療效及海洛因使用者腦部影像學之研究---一雙中心前驅世代研究
    The Study of Treatment Outcome of Methadone Maintenance Therapy and Brain Image among Heroin Users---A Two Centers' Prospective Cohort Study
    Authors: 賴德仁;陳錦宏;李俊德;田雨生;劉益瑞
    Lai, Te-Jen;Li, Chun-The;Lee, June-Der;Lee, Jing-Der;Tyan, Yeu-Sheng;Liu, Yi-Jui
    Contributors: 中山醫學院醫學研究所
    Keywords: 美沙冬維持療法;海洛因濫用;人體免疫缺乏病毒;C型肝炎;核磁共振影像;散佈性張量核磁共振影像
    Methadone maintenance treatment (MMT);Heroin abuse;Humanimmunodeficiency virus(HIV);Hepatitis C;Magnetic resonance iaging (MRI);Diffusion tensor magnetic resonance imaging(DT-MRI)
    Date: 2009
    Issue Date: 2010-12-17T02:58:21Z (UTC)
    Abstract: 預估全世界超過8千萬人目前在使用海洛因或鴉片類物質。海洛因使用者之死亡率及自殺率均高於一般人。海洛因被認為是一種“慢性而復發”的疾病，此外，海洛因依賴可以造成巨大的社會及經濟的負擔，預計將近0.4%的GDP，包括犯罪、失業、關係崩解及法律處遇的費用。美沙冬維持療法（Methadone maintenance treatment, MMT）是治療海洛因成癮的最有效方法之一。統合分析（meta-analysis）顯示美沙冬的效益最明顯在於降低物質使用相關的犯罪行為，對於降低海洛因使用及HIV危險行為也有中等的效果。同樣的美沙冬在經濟效益上可減輕後續相關社會資源及司法系統的負擔。台灣近年來才從犯罪觀點改變成疾病觀點來看待海洛因使用者，因而開始引進海洛因治療模式，因此關於本土之MMT患者特性研究極少，而這些特性對MMT預後的影響所知更是缺乏。目的：本研究的主要目的為二部分：(1)以一世代研究設計，建立以下的本土性MMT患者特性資料，包括：進入MMT治療海洛因依賴患者之特性、海洛因及其他合併物質使用特性、精神疾患的共病性、HIV、B型肝炎、C型肝炎、自殺行為盛行率以及影響這些特性的相關因子，並期待在未來的世代追蹤中評估這些因子對預後之影響。(2)比較海洛因依賴患者與健康對照組的腦部核磁共振影像檢查(Magnetic Resonance Imaging, MRI)與腦部散佈性張量核磁共振影像檢查(Diffusion Tensor Magnetic Resonance Imaging，DT-MRI)影像結果，評估海洛因依賴患者的腦部白質纖維是否有異常的發現。方法：此為一個前驅性(prospective)、兩個醫療中心之世代研究(cohort study)之一部分，此為第一年研究，主要為研究進入MMT治療模式之海洛因使用者特性，作為持續追蹤其治療效果的基本資料。本研究在兩治療中心（中山醫學大學附設醫院及草屯療養院）進行，研究個案需符合的條件：至少一年以上的海洛因使用、符合DSM-IV海洛因依賴的診斷標準、一個月內未接受海洛因治療者、大於或等於18歲、無嚴重生理疾病、可以瞭解研究內容及願意簽署同意書。評估項目為：海洛因及合併其他物質使用特性、精神疾患的共病性、HIV，B型肝炎、C型肝炎及自殺行為盛行率，評估時間為患者在進入MMT治療的第一天，收案時間為一年。另外，取以上研究個案中的18名海洛因依賴病患當成疾病組，也收取年紀相符合(age-matched)的18名健康志願者當對照組，皆施以brain MRI與brain DT-DTI檢查且比較兩組的影像差異。各向異性分數(Fractional Anisotropy, FA)代表腦部白質纖維徑束完整性的指數，brain DT-DTI 就是用來呈現所選定腦部區域的FA值，當FA值下降代表老化或疾病因素導致腦部白質纖維徑束完整性的缺損。結果：共270位參加MMT治療的海洛因使用者接受評估，其中87.4%有毒品前科，57.9%有非毒品前科，一年內有自殺意念者有18.8%，而終身自殺嘗試盛行率為12.9%。關於精神疾患部分的共病分析，目前合併有重鬱症者25.2%，HIV盛行率為10.9%，而HBV 盛行率為83.3%，HCV盛行率為84.6%。海洛因依賴組與健康對照組兩組在right temporal white matter(FA=0.433, FA=0.506)及left temporal white matter(FA=0.445, FA=0.506)的FA檢定上，則皆呈現統計上的顯著差異(p=0.000, p=0.000)，疾病組的平均FA值均較健康組為低。結論：海洛因使用者的特性，包括高犯罪率、高自殺嘗試率、高重鬱症共病性、高風險的危險行為。另外，本研究也顯示海洛因依賴的病人可能在顳葉白質的神經纖維徑束出現微細結構的病變。
    Background: Methadone maintenance treatment (MMT) is one of the most efficient methods to deal with heroin dependence. In Taiwan, there is lack of knowledge for the characteristics of heroin uses entering the MMT program. Objectives: The aims of presents study are (1) To establish the databank of MMT treatment model in Taiwan. (2) To compare the differences of brain magnetic resonance imaging (MRI) and diffusion tensor magnetic resonance imaging (DT-MRI) between heroin users and healthy people. Methods: The study was carried out at Chung Shan Medical University Hospital and Tsaotun Psychiatric center. Eligibility criteria of participants were:(1) heroin use more than one year, (2) meet the DSM IV criteria of heroin dependence, (3) no treatment of heroin dependence in the preceding month, (4) aged equal or more than eighteen, (5) no severe physical disorders, (6) able to understand and provide written informed consent .The contents of evaluation included characteristics of heroin use and other substances, comorbidity of psychiatric disorders, HIV, Hepatitis B, C and suicide. Eighteen individuals among them were recruited to attend the tests of brain MRI and brain DT-MRI. Eighteen healthy volunteers matched by age were compared. Results: Two hundred and seventy heroin users attending MMT treatment program were recruited. Among them, 87.9% reported to have substance crime record, 57.9% with non-substance related crime behavior, 18.8% of cases revealed suicide ideation within one year and 12.9% ever harmed themselves. For the non-substance psychiatric morbidity, 26.7% experienced at least one current Axis I disorder, and most of them were major depressive disorder (25.2%). The prevalence rates of HIV, HBV and HCV were 10.9%, 83.3% and 84.6% respectively. The comparison in brain DT-MRI showed significant reduction in FA in the region of the right and left temporal white matter of patients with heroin dependence. Conclusions: The characteristics of patients with heroin user included higher criminal behavior, higher rate of suicide attempts, higher co-morbidity with major depression, and higher risky behaviors. Results of neuroimaging revealed the possible microstructural abnormalities on white matter of temporal regions in patients with heroin dependence.
    URI: https://ir.csmu.edu.tw:8080/handle/310902500/3288
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