初探單純酒癮與酒癮合併憂鬱症患者大腦血清素轉運體顯影與認知功能之關連性

Preliminary study on the correlation between cognitive function and serotonin transporter image in patients of pure alcoholism and depressive alcoholism

林仁政(Jen-Cheng Lin)

指導教授 ： 譚偉象

中原大學/理學院/心理學研究所/碩士(2007年)

https://doi.org/10.6840/cycu200700089

摘要

一、研究背景
臨床上，酒癮患者眾多，由於酒癮常伴隨其他精神疾患發生，目前的診斷系統在診斷酒癮類別上已不敷使用。流行病學研究已證實酒癮與憂鬱症具有高共病性，但兩者共病的機制仍無一致的結論。Lesch等人指出，如果血清素轉運體基因具有易脆性，則容易發展出酒癮、憂鬱症、焦慮症等疾患。然單純酒癮與酒癮合併憂鬱症症狀上仍有相當差異，是否因為其生理病因不同而導致不同症狀，仍有待進一步研究。
二、研究目的
本研究主要目的為：(一)探討血清素轉運體在單純酒癮、酒癮合併憂鬱以及憂鬱症三種不同疾病類型下之差異性。(二)探討認知神經功能在單純酒癮、酒癮合併憂鬱、憂鬱症三種不同疾病類型以及控制組之差異性。(三)探討血清素轉運體以及認知神經功能在單純酒癮、酒癮合併憂鬱、憂鬱症三種不同疾病類型以及控制組之關聯性。
三、研究方法
(一)受試者：單純酒癮5人、憂鬱症組15人、酒癮合併憂鬱症組9人、正常受試者6人，總共35名受試者。
(二)研究工具：所有受試者皆接受WCST、Stroop、HKLLT以及123I-ADAM單光子電腦斷層掃描。
(三) 研究流程：所有受試者皆經過詳細說明並同意後填寫受試者說明書後並經過受精神疾病診斷晤談確定診斷並符合各組之篩選條件後正式收案，接受WCST、Stroop、HKLLT以及123I-ADAM單光子電腦斷層掃描。
(四) 統計分析：以無母數統計法：克-瓦單因子等級變異數分析分別比較各組血清素轉運體、認知功能差異；利用積差相關比較各組血清素轉運體以及各認知功能關聯性。
四、研究結果
在各腦區血清素轉運體方面，正常控制組與憂鬱症組在額葉上達顯著差異。在認知功能方面，僅憂鬱症組與正常控制組在隨機-學習有顯著不同。在血清素轉運體以及認知功能關聯性上，合併各組比較後，並無明顯關聯性。
五、結論
本研究支持三組病人組額葉血清素轉運體皆比正常控制組為高。此一發現為過去從事血清素轉運體影像相關研究所未發現的。過去僅在病理解剖上發現此一現象，如今影像上的發現也更加證實酒癮以及憂鬱症可能在血清素轉運體上出現功能損害的狀況。不過從結果並不能推論神經心理測驗分數與血清素轉運體有關係，也不能推論支持本研究酒癮次分類的方式。

關鍵字

單純酒癮 ； 酒癮合併憂鬱症 ； 單光子電腦斷層掃描

並列摘要

It is found in clinical research that patients with alcoholism often had many psychiatric symptoms too. Therefore it seems that the present diagnostic system for alcoholism is not adequate. Results of epidemiological studies have proved that there is strong relation between alcoholism and major depression, but the exact mechanism is still not well known. Lesch et al. indicated that if the gene of the serotonin transporter is vulnerable, it will lead to symptoms such as alcoholism, depression, and anxiety. However, there are still differences between alcoholism with and without depression. It is worth to study the relationship between the physiological pathway and symptoms of these disorders.
The main purposes of this study are: 1. Investigate the differences of the amounts of serotonin transporter among patients with pure alcoholism, depressive alcoholism, and major depression respectively. 2. Investigate the differences of neurocognitive functioning among patients with pure alcoholism, depressive alcoholism, major depression respectively, and the controlled group. 3. Study the relationship between the amounts of serotonin transporter and neurocognitive functioning among the above four groups.
There were four groups of participants. The pure alcoholism group, major depression group, depressive alcoholism group, and normal control group have 5, 15, 9, and 6 participants respectively. Informed consent was obtained from each participant, who received the administration of WCST, Stroop, HKLLT and 123I-ADAM SPECT scanning. The nonparametric Kruskal-Wallis one-way analysis of variance and Pearson’s product correlation were used for statistical analysis. Results indicated that the control group and the major depression group had significant differences in the amounts of serotonin transporter in five brain regions. There was significant difference on random learning ability between the depression and control groups. The number of trials to complete the first category of the WCST had significant correlation with the amounts of serotonin transporter for the pure alcoholism group.
In this study, the amounts of serotonin transporter in the frontal region of all the three patient groups were higher than that of the control group, which was the first time discovered in the field of serotonin transporter image research. This phenomenon had been discovered in pathological dissection. These results support that alcoholism and depression might have some relations with the amounts of serotonin transporter. However, both the hypotheses on the correlation between neuropsychological test scores and the amounts of serotonin transporter, and the proposed alcoholism classification method were not supported.

並列關鍵字

123I-ADAM ； SPECT ； Cognition function ； Pure alcoholism ； depressive alcoholism

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