烟草依赖是一种亟待防治慢性疾病.ppt

* * * * * * * * * * * Key Point Nicotine stimulates dopamine release in areas of the brain that are believed to be involved in the reward and satisfaction effect associated with smoking. After inhalation, nicotine preferentially binds to nAChR located in the mesolimbic-dopamine system of the brain within seconds. Nicotine specifically activates ?4β2 nicotinic receptors in the ventral tegmental area (VTA), causing an immediate dopamine release at the nAcc. The dopamine release is believed to be a key component of the reward circuitry associated with cigarette smoking. Reference Picciotto MR, Zoli M, Changeux J-P. Use of knock-out mice to determine the molecular basis for the actions of nicotine. Nicotine Tob Res. 1999;1:S121-S125. * 尼古丁成瘾是吸烟难戒断的根本原因 从烟草中反复摄取尼古丁会导致大脑的神经通路发生变化。尼古丁成瘾环路从尼古丁与大脑中的尼古丁受体的结合开始。 1. 尼古丁能与中脑腹侧被盖区的尼古丁乙酰胆碱受体(nAchR)结合，使尼古丁乙酰胆碱受体构象上发生变化 2. 受体的通道打开，阳离子通过，增加中脑腹侧被盖区内多巴胺神经元的冲动，使伏隔核中多巴胺的释放增加，导致许多种吸烟者追求的精神性的效应，包括愉悦感、尼古丁“快感”，以及其它奖赏感受。 3. 当尼古丁浓度降低后，受体恢复开放状态导致过度兴奋从而引起尼古丁渴求。吸烟是为了获得更多的尼古丁，释放更多的多巴胺，以得到愉悦和安静 * * * * Key Point Addiction is a chronic, relapsing disease associated with numerous medical, social,and occupational consequences. The addictive process is characterized by an intensifying series of events that ultimately culminates in drug addiction. Patients progress from occasional social drug use to a pattern of escalating compulsive use with reduced control over limitation of drug use. Ultimately, they show chronic compulsive drug-seeking behavior and emergence of negative emotional states (eg, anxiety, irritability) when access to the drug is limited. A number of factors contribute to each person’s individual susceptibility to the addictive process. These factors include genetics, environmental stressors, and a number of conditioning effects. Although some patients succeed in their attempts to abstain from drug use, the medical, social, and occupational consequences that develop during the course of the addiction do not resolve immediately. The