中国中西医结合影像学杂志2024，Vol.22Issue(1)：4-11,8.DOI:10.3969/j.issn.1672-0512.2024.01.002
经皮耳穴迷走神经电刺激治疗难治性及非难治性抑郁症的脑效应比较
Comparison of brain effects of transcutaneous auricular vagus nerve stimulation for treatment-resistant and non-treatment-resistant depression
摘要
Abstract
Objective:To compare the brain effects of transcutaneous auricular vagus nerve stimulation(taVNS)on brain function in patients with treatment-resistant depression(TRD)and non-treatment-resistant depression(nTRD).Methods:24 patients with TRD and 31 patients with nTRD were enrolled.All patients received taVNS treatment for eight weeks.Resting-state fMRI(fMRI)was performed before and after treatment.The 17-item Hamilton Rating Scale for Depression(HAMD-17)was used as the primary clinical efficacy indicator,while the Ruminative Response Scale(RRS)served as the secondary indicator.The amplitude of low-frequency fluctuation(ALFF)values before and after treatment between the two groups were compared by mixed effect analysis.Results:After treatment,the HAMD-17 scores of the two groups and the RRS scores of the nTRD group showed a significant reduction(both P<0.001).In the fMRI results,ALFF values of the left thalamus/hypothalamus/globus pallidum and the right primary visual cortex in the nTRD group were significantly lower than those of the TRD group before treatment(both P<0.001).After treatment,the nTRD group demonstrated a significant increase in ALFF values in the left posterior central gyrus and the right precentral gyrus and a significant decrease in ALFF value in the right insular lobe(all P<0.05);the TRD group demonstrated a significant increase in ALFF value in the left posterior central gyrus and a significant decrease in ALFF value in the right insular lobe(both P<0.05).Mixed-effect analysis results showed that the left orbitofrontal gyrus and right cerebellar Crus2 were the different brain regions between the TRD group and the nTRD group before and after treatment;the nTRD group had a significant decrease in ALFF values in the left orbitofrontal gyrus and right cerebellar Crus2 after treatment,while the TRD group had a significant increase in ALFF values in the left orbitofrontal gyrus and the right cerebellum Crus2(all P<0.05).Conclusions:TaVNS is effective in treating depression,but not effective in improving rumination in TRD patients.The brain mechanisms of TRD and nTRD are different.TaVNS has the ability to modulate crucial brain regions involved in depression,including the insula and orbitofrontal medial gyrus.The cerebellum may play a role in the brain mechanism of taVNS modulation of depression.These distinct brain regions may be multiple targets for the treatment of TRD and nTRD.The brain effect mechanisms of taVNS in the treatment of TRD and nTRD are different.These distinct mechanisms highlight the complexities and individualized nature of depression treatment,and further research is needed to fully understand the neurobiological basis of TRD and nTRD.关键词
经皮耳穴迷走神经电刺激/难治性抑郁症/低频振幅/静息态磁共振成像/脑效应Key words
Transcutaneous auricular vagus nerve stimulation/Treatment-resistant depression/Amplitude of low-frequency fluctu-ation/Resting-state functional magnetic resonance imaging/Brain fuction引用本文复制引用
陈庆燕,罗屹,马跃,郭春蕾,高山山,方继良..经皮耳穴迷走神经电刺激治疗难治性及非难治性抑郁症的脑效应比较[J].中国中西医结合影像学杂志,2024,22(1):4-11,8.基金项目
中国中医科学院科技创新工程项目(CI2021A03301) （CI2021A03301）
国家自然科学基金面上项目(82174282,81774433) （82174282,81774433）
中央高水平中医医院临床研究和成果转化能力提升项目(HLCMHPP2023072,HLCMHPP2023094). （HLCMHPP2023072,HLCMHPP2023094）
