Chen Li-Mei, Li Xiao-Jiao, Xu Ke, Guo Chun-Lei, Zhang Guo-Lei, Han Ming, Wang Zhi, Rong Pei-Jing, He Jia-Kai, Sun Ji-Fei, Xu Feng-Quan, Wang Hong-Xing, Fang Ji-Liang
Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700.
Zhen Ci Yan Jiu. 2021 Oct 25;46(10):869-74. doi: 10.13702/j.1000-0607.20210241.
To explore the neuromechanism of trans-auricular vagus nerve stimulation (taVNS) for treatment-resistant depression(TRD) based on functional brain network.
Twenty-eight patients with TRD were recruited from the psychiatric clinic or by the advertisement. The patients were treated by taVNS (5 Hz/20 Hz, 4-8 mA) at the auricular concha for 30 min, twice daily for 8 weeks. The symptom severity was assessed by 17-Item Hamilton Rating Scale for Depression (HAMD-17, ranging from 0 to 54 points, higher score indicates more severe conditions). Resting state fMRI data of the brain were collected to analyze changes of the regional homogeneity (ReHo), amplitude of low frequency fluctuation (ALFF) and resting state functional connectivity (rs-FC) before and after 8 weeks' taVNS by using DPARSF toolkit and the correlation between the rs-FC and clinical scale score was analyzed to assess the related brain mechanisms.
Twenty-four patients finished the clinical study, and 23 patients finished the fMRI tests. After the treatment, the average score of HAMD-17 was significantly decreased (<0.01), with the reduction rate being 66.95%; the ALFF and ReHo values of the right insula and putamen, the ReHo values of the right caudate nucleus and thalamus, as well as the rs-FC values of the right insula, left superior frontal gyrus and middle frontal gyrus were all significantly decreased (<0.05). The reduced ReHo value in the right insular lobe was negatively correlated with the HAMD score reduction (=0.001, =-0.633). The rs-FC values of the right insula lobe and the left superior frontal gyrus were significantly negatively correlated with the reduced HAMD score(=0.012, =-0.512).
TaVNS significantly relieves the symptoms of TRD patients, which may be related to its functions in regulating functional changes of the right insular and the left frontal gyrus network, and the limbic area and basal ganglia.
基于脑功能网络探讨经耳迷走神经刺激（taVNS）治疗难治性抑郁症（TRD）的神经机制。
从精神科门诊或通过广告招募28例TRD患者。患者在耳甲处接受taVNS（5Hz/20Hz，4 - 8mA）治疗30分钟，每日2次，共8周。采用17项汉密尔顿抑郁量表（HAMD - 17，评分范围0至54分，分数越高病情越严重）评估症状严重程度。采集大脑静息态功能磁共振成像（fMRI）数据，使用DPARSF工具包分析8周taVNS治疗前后局部一致性（ReHo）、低频振幅（ALFF）和静息态功能连接（rs - FC）的变化，并分析rs - FC与临床量表评分之间的相关性以评估相关脑机制。
24例患者完成临床研究，23例患者完成fMRI测试。治疗后，HAMD - 17平均得分显著降低（<0.01），降低率为66.95%；右侧岛叶和壳核的ALFF及ReHo值、右侧尾状核和丘脑的ReHo值以及右侧岛叶、左侧额上回和额中回的rs - FC值均显著降低（<0.05）。右侧岛叶ReHo值降低与HAMD评分降低呈负相关（=0.001，=-0.633）。右侧岛叶与左侧额上回的rs - FC值与HAMD评分降低显著负相关（=0.012，=-0.512）。
TaVNS可显著缓解TRD患者症状，这可能与其调节右侧岛叶和左侧额回网络以及边缘系统和基底神经节的功能变化有关。
