强戒期间冰毒滥用者HPA轴功能的动态变化过程

论文总字数：30462字

摘 要

冰毒是一种中枢神经系统兴奋剂。长期滥用冰毒会削弱个体的HPA轴功能活性。评估冰毒滥用者在强戒期间HPA轴的动态变化过程有助于理解该机制。以往相关研究主要存在两大不足。第一，现有研究大多数以单一指标皮质醇来评价HPA轴的活性。然而，皮质醇作为HPA轴的最终产物，也参与了负反馈调节，它不能反映HPA轴的综合信息，不能将HPA轴的响应活性和负反馈活性区分开。第二，现有相关研究多采用唾液、血液和尿液指标等急性或短期生物标记，聚焦于HPA轴的短期活性，缺乏评价长期HPA轴活性的研究。因此，本研究采用头发多种指标评价HPA轴活性，旨在探明强戒期间冰毒滥用者HPA轴功能的动态变化。

本研究首先通过横断研究，比较处于滥用、戒断、康复等状态的滥用者HPA轴功能的差异。然后，通过追踪研究，进一步验证横断研究的结论，即探明冰毒滥用者在毒品滥用-戒断-康复过程中HPA轴水平的动态变化过程。

研究结果如下：

1．以105名隔离戒毒人员为被试的横断研究发现，处于不同吸戒毒状态下的被试头发皮质醇含量、头发可的松含量、头发脱氢表雄酮含量、皮质醇/可的松的比值以及皮质醇/脱氢表雄酮的比值均存在显著差异(ps lt; 0.05)。

2. 以30名处于毒品滥用状态为被试的追踪研究发现，头发皮质醇含量、头发可的松含量、头发睾酮含量、头发孕酮含量、皮质醇/睾酮的比值以及皮质醇/脱氢表雄酮的比值均存在显著差异(ps lt; 0.01)。

总之，随着吸戒毒状态的改变，冰毒滥用者的HPA轴功能发生变化。采用包含八个指标的多指标评价体系能够更加全面、更加灵敏的反映HPA轴的活性。

关键词：头发，冰毒滥用者，多指标评价体系，HPA轴的长期活性

Abstract

Methamphetamine is a central nervous system stimulant. Its long-term abuse can impair the individual's HPA functional activity. In order to understand the mechanism in depth, the investigations on the changes of the HPA activity from the abuse state to the withdrawal and/or even to the abstinence state were done in the previous. However, there were two major shortcomings in the relevant studies in the past. Firstly, most studies utilized a single indicator (i.e., cortisol) to evaluate the activity of the HPA axis. However, cortisol does not reflect the comprehensive information of the HPA axis and does not distinguish the responsiveness from the negative feedback activity of the HPA axis because it as the final product of the HPA axis is also involved in negative feedback regulation. Secondly, indicators in saliva, blood, and urine mostly used the related studies are acute or short-term biomarkers focusing on the short-term activity of the HPA axis. They cannot reliably reflect long-term HPA axis activity. Therefore, this study aimed to investigate the changes of HPA activity during the period from the abuse state to the withdrawal and even to the abstinence state on methamphetamine abusers by using eight hair biomarkers to evaluate HPA axis activity

This study firstly examined the difference in HPA activity among the states of abuse, withdrawal, and abstinence through the cross-sectional design and then investigated the dynamic changes of the HPA activity during the abuse-withdrawal-abstinence process of methamphetamine through the longitudinal design.

The results are listed as follows. The cross-sectional study on 105 abusers found that there were significant differences in cortisol, cortisone, dehydroepiandrosterone (DHEA), the ratio of cortisol to cortisone and the ratio of cortisol to DHEA in hair among the drug abuse state, withdrawal state for one month, two months and three months, and abstinence (i.e. withdrawal for 4 months and over) (ps lt; 0.05), but there were no differences in testosterone, progesterone and the ratio of cortisol to testosterone (ps gt;0.05). A follow-up study on 30 subjects found that there were significant differences in cortisol, cortisone, testosterone, progesterone, the ratio of cortisol to testosterone and the ratio of cortisol to DHEA in hair (ps lt; 0.01), but there were no differences in the other hair biomarkers (ps gt;0.05).

In conclusion, the HPA activity is changed with the abuse or withdrawal state of the drug. Additionally, the results implied that the multi-indicator system based on eight indicators can reflect the activity of the HPA axis more comprehensively and more sensitively.

KEY WORDS: hair, ice abusers, multiple biomarkers, long-term HPA activity

目 录

摘 要 I

Abstract II

第一章 文献综述 1

1.1 冰毒滥用人群 1

1.1.1冰毒 1

1.1.2冰毒滥用人群的现有研究 1

1.2 HPA轴 2

1.2.1HPA轴与应激 2

1.2.2评价HPA轴活性 3

1.2.3冰毒滥用与HPA轴 3

1.3 皮质醇及其不足 4

1.3.1皮质醇与HPA轴 4

1.3.2单一指标的不足 5

1.4 多指标评价体系 5

1.4.1多指标的选取依据 5

1.4.2多指标评价体系的优越性 6

1.5 生物基质的选取 6

1.5.1以往基质的不足 6

1.5.2头发基质 7

第二章 问题提出与研究内容 9

2.1 问题提出 9

2.2 研究目的 9

2.3 研究内容 9

第三章 研究方法 10

3.1 研究设计 10

3.1.1 横断设计 10

3.1.2 追踪设计 10

3.2 研究对象 11

3.3 数据分析 11

3.4 统计分析 11

第四章 研究结果与讨论 13

4.1结果 13

4.1.1 横断研究结果 13

4.1.2 追踪研究结果 17

4.2讨论 22

第五章 结论、不足和展望 24

5.1 结论 24

5.2研究不足与展望 24

参考文献（References） 26

致谢 28

第一章 文献综述

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