Front Psychiatry. 2018; 9: 130.
E hatisitsoe Inthaneteng 2018 Apr 10. doi: 10.3389 / fpsyt.2018.00130
PMCID: PMC5902502
PMID: 29692743
Sujin Bae,1 Ji Sun Hong,2 Letsatsi Mi Kim,2 'me Doug Hyun Han2,*
inahaneloang
Selelekela
Bothata ba lipapali tsa inthanete (IGD) le bokuli ba papali ea chelete (GD) li arolelana litšobotsi tse tšoanang tsa kliniki empa li bonts'a mekhoa e fapaneng ea ts'ebetso ea ts'ebetso ea boko. Bupropion e tsejoa hore e sebetsa hantle bakeng sa kalafo ea bakuli ba nang le IGD le GD. Re ts'elisitse hore lupropion e kanna ea sebetsa bakeng sa kalafo ea marang-rang a ts'ebeliso ea ho becha ka marang-rang (ibGD) le IGD le hore likhokahano lipakeng tsa netweke ea kamehla mode (DMN) le netweke ea taolo ea cognitive (CCN) li tla fapana pakeng tsa bakGD le bakuli ba IGD kamora 12 libeke tsa kalafo ea bupropion.
mekhoa
Bakuli ba 16 ba nang le IGD, bakuli ba 15 ba nang le ibGD, le lithuto tse phetseng hantle tsa 15 ba ile ba ngolisoa boithuto bona. Motheong oa pele le kamora libeke tsa 12 tsa kalafo ea bupropion, matšoao a kliniki a bakuli ba nang le IGD kapa ibGD a ile a hlahlojoa, mme ts'ebetso ea boko e ile ea hlahlojoa ho sebelisoa ho phomola hoa ts'ebetso ea matla a ts'ebetso ea matla a boselamose.
Results
Kamora kalafo ea lupropion ea beke ea 12-beke, matšoao a kliniki, ho kenyelletsa ho teba ha IGD kapa GD, matšoao a sithabetsang, tlhokomelo, le ho ts'oenyeha ho ntlafalitsoe ka lihlopha tsena ka bobeli. Sehlopheng sa IGD, khokahanyo e sebetsang (FC) kahare ho DMN ea morao-rao le FC pakeng tsa DMN le CCN e fokotsehile ka mor'a kalafo. Ntle le moo, FC ka har'a DMN sehlopheng sa IGD e ne e matahantsoe hantle le liphetoho lipotsong tsa bacha ba marang-rang a li-addiction tsa New Internet kamora nako ea kalafo ea bupropion. Sehlopheng sa ibGD, FC kahare ho poso ea DMN e ile ea fokotseha ha FC kahare ho CCN e eketseha kamora nako ea kalafo ea bupropion. Ntle le moo, FC ka har'a CCN sehlopheng sa ibGD e ne e le kholo haholo ho feta sehlopheng sa IGD.
fihlela qeto e
Bupropion e ne e sebetsa hantle ho ntlafatsa matšoao a bakuli ho bakuli ba nang le IGD le ibGD. Leha ho le joalo, ho ne ho e-na le liphapang liphatlalatsong tsa meriana har'a lihlopheng tsena tse peli. Kamora libeke tsa 12 tsa kalafo ea lupropion, FC ka har'a DMN hammoho le pakeng tsa DMN le CCN e fokotsehile ho bakuli ba IGD, athe FC kahare ho CCN e eketsehile ho bakuli ba ibGD.
Selelekela
Papali ea marang-rang e sebelisoang marang-rang ke mofuta o fetotsoeng oa papali ea chelete o sebelisang lisebelisoa tse lumelloang Inthaneteng, ho kenyeletsoa likhomphutha, mehala ea thelefono le thelevisheneng ea dijithale (1, 2). Ka lebaka la litšobotsi tsa lits'ebetso tsa inthanete tse kang lebelo le boiketlo ba ho fumaneha, papali ea chelete e sebelisang marang-rang e ka ba le mokhoa oa ho arabela ka potlako mme ea fana ka phihlello e bonolo ea likhetho tse fapaneng tsa ho becha (1, 2). Lilemong tse mashome a mabeli tse fetileng, bothata ba lipapali tsa inthanete (IGD) bo 'nile ba nkuoa e le lefu la kelello le tšoauoang ke takatso ea papali (papali ea papali ea chelete), nako e ngata ea ho bapala le litlamorao tse mpe (3). Ka lebaka la ho ts'oana ho teng lipakeng tsa IGD le ts'ebeliso ea marang-rang e amanang le papali ea marang-rang (ibGD) mabapi le matšoao a ts'ebeliso ea ts'ebeliso e feteletseng le litlamorao tse mpe tse ka bang teng, lithuto tse 'maloa li bontšitse hore IGD e kanna ea bapisoa ka ho hlaka le ibGD (4). Ka lebaka la mefuta ena ea tlhahlobo ea mafu, meriana ea bothata ba ho becha (GD), ho kenyelletsa escitalopram le bupropion, le eona e sebelisitsoe ho IGD (5-8). Leha ho le joalo, ho bile le likhang mabapi le tlhahlobo ea IGD e le tšibollo ea taolo kapa tšusumetso ea taolo (3, 9, 10) hammoho le phapang pakeng tsa ts'ebetso ea boko e sebetsang (FC) ka har'a khokahano ea kelello e lipakeng tsa maloetse ana a mabeli (11). Ka hona, papiso e ka bapisoa le litlamorao tsa meriana ho mafu ana a mabeli.
Har'a meriana e 'maloa e tsejoang e sebetsa hantle bakeng sa ho fokotsa matšoao a GD (5, 6), bupropion e khothalelitsoe ho ntlafatsa matšoao a IGD (8, 12). Bupropion e sebetsa hantle bakeng sa ho phekola bakuli ba nang le GD ka ho fokotsa boitšoaro ba papali ea chelete le palo ea chelete e sebelisitsoeng (5, 6). Fekete et al. (5) e tlaleha hore bupropion e ne e sebetsa ebile e mamellehile hantle ho bakuli ba nang le GD (5). Dannon et al. (6) ba khothalelitse hore bupropion e sebetsa joaloka naltrexone ho latela mochine oa eona oa ho laola ho lokolloa ha dopamine. Bupropion e etsa mosebetsi oa ho thibela ho khutlisoa hape ha dopamine le norepinephrine ka ho susumetsa acetylcholine, hydroxytryptamine, gamma aminobutyric acid receptor, le endorphin signing (13). Lits'ebetso tsena tsa methapo ea kutlo li ka tsamaisana le litakatso, ho lakatsa, le ho natefeloa ke boits'oaro ba papali ea chelete le bokhoba ba lithethefatsi tsa tlhekefetso (14). The opioid antagonist naltrexone e ka thibela ho ntshwa ha dopamine ka joala ka har'a li-bokellase tsa nucleus, tse fokotsang takatso ea joala le ho khothaletsa ho itlopa joala.15). Boithuto bo khothalelitse hore bupropion e ka ntlafatsa matšoao a IGD ka ho ntlafatsa matšoao a sithabetsang a comorbid le ho kenya phetoho diketsong tsa boko (8, 16). Libeke tse leshome le metso e 'meli tsa kalafo ea lupropion li bontšitsoe ho ntlafatsa matšoao a IGD hammoho le matšoao a sithabetsang ho bakuli ba nang le khatello e kholo ea khatello ea maikutlo le IGD (8). Phuputsong e 'ngoe, libeke tsa 6 tsa kalafo ea bupropion li fokolitse ho teba ha IGD ka ho fokotsa ts'ebetso ea boko kahare ho corsex ea dorsolateral pele ho arabela ts'usumetso ea papali (16).
Phuputsong ea rona e fetileng ho bapisa khokahano ea boko ea netweke ea default mode (DMN) le netweke ea cognitive control network (CCN) lipakeng tsa IGD le ibGD, lihlopha tsena ka bobeli li bontšitse ho fokotseha ho ts'oanang ha FC ho DMN. Leha ho le joalo, FC ka har'a CCN e ile ea eketseha sehlopheng sa IGD empa eseng sehlopha sa ibGD (11). DMN e bua ka libaka tse hlophisitsoeng tse arolelanoang ka mokhoa o tšoanang nakong ea ts'ebetso ea mosebetsi mme haholo-holo e sebetsang nakong ea phomolo (17). DMN hangata e ne e nahanoa hore e kenyelletsa posterior cingrate cortex (PCC), precuneus, medial frontal cortex (mPFC), ventral anterior cingulate cortex (ACC), and lateral (LP) and inferior parietal lobes (IP) (17). Ho bakuli ba itšetlehileng ka lintho tse sebelisang matla, bokong FC kahare ho DMN e ne e tsamaellana hantle le ho ts'oaroa ha (18). Ho bakuli ba nang le GD, ho fokotsehile FC kahare ho DMN ho tloha ho PCC ho ea ho leqele le phahameng ka ho le letšehali, gyrus e bohareng ea lets'oao, le precuneus ho tlalehiloe. Ntle le moo, boteng ba GD bo ne bo amana hantle le FC ho tsoa ho PCC ea peo ho ea ho precuneus (19). Leha ho le joalo, lithuto tsa pejana ho FC ka har'a DMN ho IGD li bonts'itse liphetho tse fapaneng (11, 12). FC kahare ho likarolo tse ka morao tsa DMN ho bakuli ba IGD e ile ea fokotseha (11). Ka lehlakoreng le leng, FC pakeng tsa DMN le network ea salience e ne e eketsehile ho bakuli ba IGD (12).
CCN e hokahane le ts'ebetso ea ho sebelisa mesebetsi e phahameng, ho kenyelletsa tlhokomelo, ho rera, le ho hopola lintlha bakeng sa ho tataisa boits'oaro bo nepahetseng ho fihlela lipheo tse ikhethileng (20). E kenyelletsa libaka tsa dorsal tsa cortex ea pele ea pele (DLPFC), ACC, le parietal cortex (20). Joalo ka ha papali ea chelete le papali ea inthanete li amahanngoa le ho etsa liqeto tse lebisitsoeng ho sepheo (21), litsebi tse 'maloa li bontšitse hore FC ka har'a CCN e ka amahanngoa le papali ea chelete le IGD (22). Ntle le moo, likhohlano le ho se tsitsinyehe ho bakoang ke ho etsa liqeto tse kotsi nakong ea mesebetsi ea papali ea chelete li ka etsa hore ho be bonolo ho etsa cortex ea dorsal.23).
Re ts'elisitse hore bupropion e ka ba molemo bakeng sa kalafo ea ibGD le IGD. Leha ho le joalo, mochine oa ts'ebetso oa bupropion kalafong ea ibGD le IGD mabapi le khokahano ea boko pakeng tsa DMN le CCN li ne li tla fapana. Re ile ra kholoa hore lupropion e ne e tla fokotsa FC pakeng tsa DMN le CCN sehlopheng sa IGD, empa e ne e tla eketsa FC kahare ho CCN sehlopheng sa ibGD.
Lisebelisoa le mekhoa
barupeluoa ba
Ho bakuli ba 15 ba nang le bakuli ba IGD le 14 ba nang le ibGD ba nkile karolo thutong ea rona e fetileng ho bapisa khokahano ea boko (11), Bakuli ba 12 ba nang le bakuli ba IGD le 12 ba nang le ibGD ba amohetse ho nka karolo thutong ena. Ntle le moo, bakuli ba supileng ba nang le IGD le bakuli ba tšeletseng ba nang le ibGD ba etelang lefapha la sepetlele sa sepetlele sa OO ba sa tsoa ngolisoa thutong ena (Setšoantšo. (Figure1) .1). Bohle ba neng ba nkile karolo ba ile ba hlahlojoa le lipotso tse fumanehang bakeng sa tlhahlobo ea bongaka ea DSM-IV.24). Nakong ea tlhahlobo e latelang, bakuli ba bararo ba nang le IGD le bakuli ba bararo ba nang le ibGD ba ile ba akheha ka lebaka la ho khaotsa ho ithaopa le phetoho ea meriana. Qetellong, bakuli ba 16 ba nang le bakuli ba IGD le 15 ba nang le ibGD ba qetile protocol ea thuto (Setšoantšo (Figure1) .1). Mekhoa ea ho kenyelletsa e ne e le ka tsela e latelang: (1) e fumanoe e na le IGD e ipapisitse le DSM-5 kapa e ikemiselitse ho ba le ibGD. Re sebelisitse mekhoa ea tlhahlobo ea GD mme re e fetotse ho theha mekhoa ea ho kenyelletsa ibGD, empa re fetotse "bothata ba papali ea chelete" ho DSM-5 ho "ibGD," (2) motho e moholo (> 18 ea lilemo li), (3) monna, le (4) meriana ea mafu a kelello-naïve. Mekhoa ea ho khetholla e ne e le ka tsela e latelang: (1) mafu a mang a comorbid a bongaka kapa a kelello, (2) low intelligence quotient (IQ) (ka tlase ho 80), (3) litemoso tsa ho skena ha MRI joalo ka claustrophobia le ho kenella ka tšepe, le (4) nalane ea ts'ebeliso e mpe ea lithethefatsi ntle le ho noa joala le ho tsuba.
Tsamaiso ea ho ithuta. Selelekela: IGD, bothata ba lipapali tsa inthanete; ibGD, bothata ba papali ea chelete bo behiloeng inthaneteng; D / O, o ile; fMRI, ts'ebetso ea ho nahana ka matla a boloi e sebetsang.
Tsamaiso
Motheo, barupeluoa bohle ba ile ba botsoa ho tlatsa lipampiri tsa lipotso tsa tlhaiso ea batho le matšoao a tliliniki. Letšoao le tebileng la ibGD le IGD le ile la hlahlojoa le Yale-Brown Obsessive Compulsive Scale bakeng sa papali ea papali ea chelete (YBOCS-PG) (25) le likotsi tsa Inthanete ea Keketso ea Inthanete (YIAS) (26), ka ho latellana. Sekala se seng sa tlhahlobo ea matšoao a kliniki se ile sa sebelisoa ho bohle ba nkang karolo: Beck Depression Inventory (BDI) (27bakeng sa matšoao a sithabetsang a maikutlo, Korea ADHD Rating Scale (K-ARS) (28) bakeng sa matšoao a ho tsotella, le Behavioral Inhibitory System le Behavioral Activation System sekala bakeng sa litšobotsi tse thibelang motho le tse ling tse susumetsang molemong oa boiphetetso kapa takatso ea boits'oaro boitshwarong (29). IQ ea barupeluoa bohle e ile ea hlahlojoa ho sebelisoa Korea-Wechsler Adult Intelligence Scale (30). Ntle le moo, barupeluoa bohle ba ile ba hlahlojoa ho sekaseka FC FC ea boko dessyecik resting state functional magnetic resonance imaging (rs-fMRI). Bakuli ka bobeli ba IGD le ibGD ba qaliloe ho bupropion SR 150 mg / letsatsi, ka nako eo e ile ea eketsoa ho 300 mg / letsatsi. Qeto ea ho fetola lethal dose e entsoe ke ngaka ea mafu a kelello (Doug Hyun Han) ketelong ea beke ea bobeli motheong oa mamello le katleho. Qetellong ea libeke tsa 12 tsa kalafo ea bupropion, likala tsa kliniki le litekanyo tsa kliniki ea rs-fMRI li ile tsa phetoa ho bohle ba nkang karolo (Setšoantšo. (Figure1) .1). Boto ea Tlhahlobo ea Sepetlele sa Sepetlele sa Chung-Ang University e amohetse protocol bakeng sa thuto ena, mme tumello e ngotsoeng e nang le tsebo e fanoe ke bohle ba nkang karolo.
Ho Fumana MRI le ho Atleha
Brain FC maemong a phomolo e ile ea hlahlojoa ho sebelisoa MN ea 3 T ea mali-oxygen-level e sebetsang e itšetlehileng ka MRI (sefuba sa Philips Achieva 3.0 T TX MRI; TR = 3 s; nako ea scan, 12 min; 240 slices; 128 × 128 matrix; 40 slices at botenya ba 4.0-mm). Preprocessing e ne e kenyelletsa ho nyenyefatsa (AFNI: 3dDespike), tokiso ea motsamao (SPM 12b), coreg usajili ho Magnetization Itokiselitseng setšoantšo sa RApid Gradient Echo (SPM 12b), normalization to MNI space (SPM 12b), temporal detrend (Matlab) filting (Matlab: borafilter.m), le rexelwise regression ea li-bandpass tse tšoanang hantle le tse ling tse lekantsoeng nako ea li-parameter tse tšeletseng tse tsamaeang ka hlooho (mehato ea tumellano le likarolo tse tšeletseng tse thata tsa 'mele tse bonts'ang motsamao oa thuto o lekantsoeng bakeng sa thuto e ngoe le e ngoe), mokelikeli o senyehileng oa "cerebrospinal" le lisele tse bonolo tsa sefahleho (Matlab) joalo ka ha ho hlalositsoe pele (31). Ho sebetsana le monyetla oa ho sisinyeha ha li-micro-hlooho tse amang sephetho sa khokahanyo (32), Ho bonoa ha lintlha tsa nako ka motsamao oa hlooho> 0.2 mm e entsoe, empa ha ho phethollo ea lets'oao la lefats'e e ileng ea etsoa (31).
Re ile ra ntša libaka tsa 12 tsa marang-rang a mabeli a boko [tse 'ne ho tsoa ho DMN: mPFC, leqeleng / leqele le latelang la parietal cortex (LPRt / LPLt), le PCC; tse robeli ho tsoa CCN: DLPFC (DLPFCRt / DLPFCLt), leqhetso le letšehali kapa leqeleng le tlaase ka ho le letšehali (PGRCR / PPCLt), mme ka ho le letona / ka ho le letšehali motho ea tsoang sebakeng sa sephethephethe sa makoloi ho tsoa ho AAL atlas. tsa boko (marang-rang.nii / .txt / .info). U sebelisa lebokose la lisebelisoa tsa khokahanyo ea CONN-fMRI e sebetsang (ver.15; www.Nitrc.org/projects/conn), Li-coefficients tse kopantsoeng tsa Fisher tse fetotsoeng li baliloe bakeng sa libaka tse peli tse khahlisang thutong ka 'ngoe. Liphello lipakeng tsa sehlopha li ne li nkuoa li le bohlokoa ka sekhahla sa sehlopha sa ho sibolla leshano (FDR) q <0.05, ho nahanoa ka khalemelo e ngata ea papiso mabapi le khalemelo ea lipara tse 66 tsa libaka tse 12.
Lipalo-palo li
Litšupiso tsa palo ea batho le tsa bongaka tsa IGD, ibGD, le lipapatso tse phetseng hantle li ile tsa hlahlojoa ho sebelisoa tlhahlobo ea liteko (phapang ea ANOVA) ka bohlokoa ba lipalo tse behiloeng ho p <0.05. Likamano lipakeng tsa sekala sa kliniki le khokahano ea boko li ile tsa hlahlojoa ho sebelisoa khokahano ea Spearman le lipalo-palo tse behiloeng ho p <0.05. Litlhahlobo tsohle tsa lipalo-palo li ile tsa etsoa ho sebelisoa SPSS 18.0 (SPSS Inc., Chicago, IL, USA).
Results
Liphetoho ho Matšoao a Clinical Kamora Libeke tsa 12 tsa Phekolo ea Bupropion
Motheo oa motheo, ho ne ho se na phapang e kholo lilemong, lilemo tsa thuto, le IQ lipakeng tsa bakuli ba IGD, bakuli ba ibGD, le lithuto tse bapisoang hantle. Leha ho le joalo, ho bile le phapang e kholo ho BISBAS (F = 6.56, p <0.01), BDI (F = 4.68, p = 0.02), K-ARS (F = 24.09, p <0.01), YIAS (F = 70.94, p <0.01), le YBOCS-PG (F = 82.68, p <0.01) lipakeng tsa lihlopha tsena tse tharo. The post hoc Teko e bontšitse hore ha ho na phapang e kholo lihlopheng tsa BDI, K-ARS, le BISBAS lipakeng tsa lihlopha tsa IGD le ibGD. Lintlha tsa YIAS sehlopheng sa IGD li ne li phahame ho feta tsa sehlopha sa ibGD (z = 4.58, p <0.01) ha lintlha tsa YBOCS-PG sehlopheng sa ibGD li ne li phahame ho feta tsa sehlopha sa IGD (z = 4.60, p <0.01) (Tafole (Tafole11).
Lethathamo 1
Boemo ba demographic le bongaka.
| IGD | ibGD | HC | |||
|---|---|---|---|---|---|
| Baseline | Tšalo-morao | Baseline | Tšalo-morao | ||
| Age | 25.3 ± 5.2 | 25.0 ± 4.9 | 25.7 ± 4.7 | ||
| Ngwaga wa thuto | 12.8 ± 2.6 | 12.1 ± 2.5 | 13.1 ± 2.3 | ||
| IQ | 99.0 ± 12.5 | 97.7 ± 15.3 | 103.8 ± 9.9 | ||
| Joala (e / che) | 10/6 | 10/5 | 12/3 | ||
| Ho tsuba (e / che) | 8/8 | 9/6 | 8/7 | ||
| BDI | 9.7 ± 56.2 | 5.7 ± 2.8 | 14.1 ± 8.3 | 9.4 ± 3.4 | 6.1 ± 4.2 |
| K-ARS | 13.0 ± 4.5 | 9.3 ± 3.1 | 18.8 ± 7.7 | 14.4 ± 4.9 | 5.4 ± 3.4 |
| BISBAS | 47.6 ± 4.9 | 47.6 ± 4.9 | 50.7 ± 6.0 | 50.7 ± 6.0 | 49.0 ± 8.1 |
| YIAS | 68.9 ± 8.8 | 54.8 ± 8.2 | 38.3 ± 9.0 | 36.5 ± 7.4 | 37.6 ± 6.6 |
| YBOCS-PG | 5.7 ± 2.2 | 5.1 ± 1.8 | 17.8 ± 4.6 | 12.2 ± 4.3 | 4.1 ± 1.8 |
IGD, bokuli ba lipapali tsa inthanete; ibGD, bokuli bo thehiloeng marang-rang bo amanang le marang-rang; HC, lithuto tsa bophelo bo botle ba papiso; IQ, quotient ea bohlale; BDI, Beck Depression Inventory; K-ARS, Sekala sa Tekanyetso sa Korea; BISBAS, Behavioral Inhibitory System Behaeveal Activation System; YIAS, Sekala sa Tlatsetso ea Inthanete sa Bacha; YBOCS-PG, Yale-Brown Obsessive Scale e Behang Leseli bakeng sa papali ea papali ea chelete.
Kamora kalafo ea lupropion ea beke ea 12-beke, BDI (z = -2.68, p <0.01), K-ARS (z = -2.81, p <0.01), BISBAS (z = -2.81, p <0.01), le YIAS (z = -2.81, p <0.01) lintlha li ntlafalitsoe sehlopheng sa IGD ha BDI (z = -2.09, p = 0.04), K-ARS (z = -2.81, p <0.01), BISBAS (z = -2.81, p <0.01), le YBOCS-PG (z = -2.80, p <0.01) lintlha li ntlafalitsoe sehlopheng sa ibGD. Leha ho le joalo, ho ne ho se na liphapang tse kholo mabapi le liphetoho mabapi le sekala sa kliniki nakong ea libeke tse 12 (Tafole (Tafole11).
Liphetoho ho Brain FC Kamora Libeke tsa 12 tsa Phekolo ea Bupropion
Sehlopheng sa IGD motheong oa motheo, FC pakeng tsa MPFC le IFGLt (t = 3.39, FDRq = 0.0026), DLPFCLt le LPRt (t = 3.34, FDRq = 0.0030), le PPCLt le IFGRt (t = 3.67, FDRq = 0.0013) e ne e phahametse ea lithuto tse phetseng hantle. Kamora libeke tse 12 tsa kalafo ea bupropion, FC lipakeng tsa PCC le LPRt (t = -3.26, FDRq = 0.0017), LPRt le PPCRt (t = -3.16, FDRq = 0.0023), le LPRt le PPCLt (t = -3.42, FDRq = 0.0012) li ne li le tlase ho feta tsa mantlha (Setšoantšo (Figure22).
Liphetoho khokahanong e sebetsang ea bokong ka mor'a libeke tsa 12 tsa kalafo ea bupropion. Mohala o khubelu: khokahano e sebetsang ea kopanyo (FC), mola o moputsoa: fokotseha FC, Sehlopheng sa IGD motheong oa motheo, khokahano ea tšebetso pakeng tsa gyrus e bohareng (MPFC) le leqhetso le letšehali la boemo bo holimo (IFGLt) (t = 3.39, FDRq = 0.0026), ka lehlakoreng le letšehali la dorsolateral prefrontal cortex (DLPFCLt) le ka ho le letona lateral parietal cortex (LPRt) (t = 3.34, FDRq = 0.0030), 'me ka morao parietal cortex (PPCLt) le IFGRt (t = 3.67, FDRq = 0.0013). Libekeng tse 12, khokahano e sebetsang lipakeng tsa posterior cingulate cortex (PCC) le LPRt (t = -3.26, FDRq = 0.0017), LPRt le PPCRt (t = -3.16, FDRq = 0.0023), le LPRt le PPCLt (t = -3.42, FDRq = 0.0012). Ka sehlopha sa ibGD qalong, khokahano e sebetsang lipakeng tsa PCC le LPLt (t = -3.36, FDRq = 0.0014), PCC le LPRt (t = -3.26, FDRq = 0.0027). Libekeng tse 12, khokahano e sebetsang lipakeng tsa PCC le PPCLt (t = -3.23, FDRq = 0.0031), PCC le PPCRt (t = -3.25, FDRq = 0.0031). Tšebelisano e sebetsang lipakeng tsa PPCLt le PPCRt (t = 3.12, FDRq = 0.0042). Papisong ea IGD vs ibGD (tlhahlobo e lekantsoeng ea phapang), sehlopha sa ibGD se bonts'a FC e eketsehile lipakeng tsa IFGRt le PPCLt (F = 3.67, p = 0.0013), ha e bapisoa le sehlopha sa IGD.
Sehlopheng sa ibGD qalong, FC pakeng tsa PCC le LPLt (t = -3.36, FDRq = 0.0014) hammoho le PCC le LPRt (t = -3.26, FDRq = 0.0027) e ne e le tlase ho feta ea lithuto tse phetseng hantle. Kamora libeke tse 12 tsa kalafo ea bupropion, FC lipakeng tsa PCC le PPCLt (t = -3.23, FDRq = 0.0031) hammoho le PCC le PPCRt (t = -3.25, FDRq = 0.0031) e fokotsehile ha e ntse e le lipakeng tsa PPCLt le PPCRt (t = 3.12, FDRq = 0.0042) e ne e eketsehile ha e bapisoa le motheo (Setšoantšo (Figure22).
Mehato e pheta-phetoang ANOVA e senotse hore sehlopha sa ibGD se bonts'itse FC e nyolohileng pakeng tsa IFGRt le PPCLt (F = 3.67, p = 0.0013), ha e bapisoa le sehlopha sa IGD (Setšoantšo (Figure22).
Khokahano Pakeng tsa Liphetoho Maemong a Clinical le Liphetoho ho Brain FC
Sehlopheng sa IGD, khokahano e sebetsang pakeng tsa PCC le LPRt e ile ea hokahanngoa ka nepo le liphetoho litsing tsa YIAS ho tloha ho isa bekeng ea 12 (r = 0.69, p <0.01). Sehlopha sa ibGD, liphetoho ho FC lipakeng tsa PPCLt le PPCRt li hokahane hampe le liphetoho lipakeng tsa YBOCS-PG ho tloha molemong oa pele ho ea ho libeke tse 12 (r = -0.68, p <Setšoantšo sa 0.01) (Figure33).
Kopano lipakeng tsa liphetoho tse sekala sa kliniki le liphetoho tse mabapi le tšebetso ea boko. (A) Sehlopheng sa marang-rang sa lipapali tsa papali ea inthanete (IGD), khokahano e sebetsang pakeng tsa posterior cingrate cortex (PCC) le tokelo ea lateral parietal cortex (LPRt) e ne e tsamaellana hantle le liphetoho tse bileng teng lenaneong la likotsi tsa Internet Internet addiction Scale ho tloha ho motheo ho fihlela libekeng tsa 12 (r = 0.69, p <0.01). (B) Sehlopheng sa ibGD, liphetoho tse ileng tsa etsahala pakeng tsa FC lipakeng tsa "posterior parietal cortex" (PPCRt) le litokelo tse nepahetseng tsa posterior parietal cortex (PPCRt) li ne li sa tsamaellane hantle le liphetoho tse teng ho Yale-Brown Obsessive Compulsive Scale bakeng sa papali ea chelete ea 'mele (YBOCS-PG) motheo ho libeke tsa 12 (r = -0.68, p <0.01).
Puisano
Liphetoho ho Matšoao a Kliniki ha a Arabela kalafo ea Bupropion
Thutong ena, kalafo ea Xipovion ea beke ea beke ea 12 e ntlafalitse ho teba ha IGD le ibGD hammoho le matšoao a amanang le kliniki a lihlopha tsena ka bobeli tsa bakuli. Katleho ea bupropion bakeng sa kalafo bakeng sa IGD e tlalehiloe lithutong tse fetileng (8, 16). Libeke tse leshome le metso e 'meli tsa kalafo ea bupropion li bontšitsoe ho fokotsa botebo ba IGD le matšoao a sithabetsang ho bakuli ba IGD ba nang le khatello e kholo ea khatello ea maikutlo (8). Ha a bapisa kalafo ea escitalopram le bupropion, bupropion e bonts'itse ts'ebetso e kholo ho ntlafatsa ho ts'oaroa le ho tsotelloa (12). Ho sebetsa hantle ha bupropion ho bakuli ba nang le GD ke taba ea ngangisano (5, 6). Le ha e le Ntle et al. (5) e tlaleha katleho le mamello ea bupropion ho bakuli ba nang le GD, ts'ebetso ea eona ea ho fokotsa matšoao a GD e ne e se kholo ho feta ea placebo (5). Leha ho le joalo, Dannon et al. (6) e phatlalalitse hore bupropion e ne e sebetsa joaloka naltrexone ho bakuli ba nang le GD (6). Ka lebaka la ketso e kopanetsoeng ea bupropion mabapi le thibelo ea norepinephrine le dopamine reuptake, ho nahanoa hore e sebetsa hantle bakeng sa ho fokotsa boits'oaro bo sa tsotelleng ho bakuli ba IGD le ibGD (33, 34). Tšusumetso ke sejo se tsebahalang sa litekanyetso tsa boits'oaro ba prototypical ka litheolelo tse tsitsitseng tsa meputso e liehang (35). Phokotso ena e nyane ea meputso e liehang e amana le tsamaiso ea methapo ea methapo ea methapo (dopamine)36).
Liphetoho ho Brain FC Kamora Libeke tsa 12 tsa Phekolo ea Bupropion
Ha a arabela libeke tsa 12 tsa kalafo ea lupropion, FC ka har'a DMN le hore pakeng tsa DMN le CCN li fokotsehile sehlopheng sa IGD, ha FC kahare ho CCN e eketseha sehlopheng sa ibGD. Lihlopha tsa IGD le ibGD li bonts'itse mekhoa e fapaneng ea boko FC ho arabela kalafo ea bupropion. Sehlopheng sa IGD, FC kahare ho DMN ea morao-rao le FC pakeng tsa DMN le CCN li fokotsehile kamora nako ea beke ea 12-beke ea kalafo. Ntle le moo, FC pakeng tsa PCC le LPRt sehlopheng sa IGD e ne e hokahane hantle le liphetoho ho YIAS kamora nako ea kalafo ea 12-beke ea beke. Liphetho tsena li ne li tsamaisana le thuto ea rona e fetileng e bonts'itseng FC e fokotsehileng kahare ho DMN le lipakeng tsa DMN le netweke ea salience (12). FC e theotsoeng kahare ho DMN e kanna ea amahanngoa le norepinephrine e ntseng e eketseha le dopamine, joalo ka ha ho hlokometsoe ho DMN ho arabela taolong ea atomoxetine (37). Ketso e kopanetsoeng ea bupropion ho ekeheng norepinephrine le ho supa dopamine e ts'oana le mokhoa oa ts'ebetso oa modafinil (38). FC e ntseng e eketseha ka har'a DMN e ne e nahanoa hore e amana le ho qobelloa, ho etsa liqeto tse kotsi le ho haelloa ke tlhokomelo (17, 39). Ka hona, ho theola FC kahare ho DMN le FC pakeng tsa DMN le marang-rang a mang ho ka fokotsa boitšoaro bo sa tsitsang, bo kang ho bapala papali ea inthanete kapa papali ea chelete.
Sehlopheng sa ibGD, FC kahare ho poso ea DMN e ile ea fokotseha ha seo kahare ho CCN se eketsehile kamora nako ea kalafo ea beke ea 12-beke. Ntle le moo, FC ka har'a CCN (IFGRt - PPCLt) sehlopheng sa ibGD e ne e phahame haholo ho feta sehlopheng sa IGD. FC kahare ho CCN (PPCLt - PPCRt) sehlopheng sa IGD e ne e hokahane hampe le liphetoho meralong ea YBOCS-PG kamora nako ea kalafo ea 12-beke ea bupropion. Ho sitoa ho itaola ho bakuli ba nang le GD ho nahanoa hore ho etsahala ka lebaka la ho sitoa ha taolo ea taolo ea pele ea tšireletso ea pele-tlase.40). Potoloho e holimo-tlase e tlalehoa e amana le liphoso tsa qeto (36) hammoho le phetisetso ea dopamine (41). Ntle le moo, libaka tsa "conto-frari-parietal cortices" li tšoarehile ka tlhokomelo e ka tlase-tlase le taolo ea kelello (42). Ka hona, ts'ebetso ea pharmacodynamic ea bupropion (dopamine stimulation) e ka ntlafatsa CCN (libaka tsa fronto-parietal) ka ho ntšetsa pele ts'ebetso kahare ho potoloho e holimo-tlase ho bakuli ba nang le ibGD. Ho nkuoa hammoho, IGD le ibGD li bonahala li arolelana litšobotsi tse ts'oanang tsa ho fokotseha le ho fokotseha ha FC kahare ho DMN kamora kalafo ea bupropion. Leha ho le joalo, bupropion e ne e sebetsa haholoanyane ho eketseng FC kahare ho CCN, e amanang le ho lokisa liphoso tsa liqeto.
sheba mefokolo ea
Ho bile le likhaello tse 'maloa thutong ena. Taba ea pele, palo e nyane ea lithuto e lekanyetsa kakaretso ea sephetho. Ka lebaka la palo e nyane ea lithuto, ke marang-rang a mabeli feela a thahasello a sebelisitsoeng ho bapisa liphetoho tsa FC lipakeng tsa lihlopha tsena tse peli ho arabela kalafo ea bupropion. Taba ea bobeli, kaha thuto ena e ne e se na sehlopha sa taolo ea placebo, re ke ke ra hlakisa monyetla oa hore re bone phello ea placebo. Kamora nako, hobane lithuto tse laolehileng tse phetseng hantle li sa ka tsa nka karolo litlhahlobong tsa morao-rao, ha re na tekanyo ea phapang e tšoanang ea tlhahlobo ea liteko. Lithuto tsa nako e tlang li lokela ho kenyelletsa palo e kholo ea lithuto le tlhaiso-leseling e latelang bakeng sa lithuto tsa taolo e phetseng hantle.
fihlela qeto e
Bupropion e bonts'a tšepiso ea ho ntlafatsa boits'oaro bo nang le mathata ho IGD le ibGD. Leha ho le joalo, pharmacodynamics of lupropion e fapane pakeng tsa lihlopha tsena tse peli, moo FC ka har'a DMN hammoho le pakeng tsa DMN le CCN li fokotsehileng ho bakuli ba nang le IGD, athe FC kahare ho CCN e eketsehile ho bakuli ba nang le ibGD kamora libeke tsa 12 tsa kalafo ea bupropion.
Boitšoaro ba Melao
Boto ea Tlhahlobo ea Sepetlele sa Sepetlele sa Chung-Ang University e amohetse protocol bakeng sa thuto ena, mme tumello e ngotsoeng e nang le tsebo e fanoe ke bohle ba nkang karolo.
Menehelo ea Mongoli
JH, SK, le DH li kentse letsoho ho bokeng bakuli, ho bokella data, le ho e lokisa. SB, JH, le DH ba hlahlobile data. Bangoli bohle ba nkile karolo ho etsa sengoloang, ba ne ba kentse letsoho tšebelisong ea bohlale bakeng sa sengoloa, mme ba bala le ho amohela mongolo oa ho qetela.
Tlhōlisano ea Tlhaloso
Ha ho na lithahasello tsa motho ka mong, tsa botsebi kapa tsa lichelete.
Mongolo o botlaaseng ba leqephe
Lithuso. Boithuto bona bo tšehelitsoe ke chelete ea lithuso e tsoang ho Korea ea Pōpo ea Boqapi ba Korea (R2014040055).
References
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